Challenges in developing health promoting schools' project: application of global traits in local realm

School health and nutrition program implementation, impact, and challenges in schools of Nepal: stakeholders' perceptions

Background

The School Health and Nutrition (SHN) program is a cost-effective intervention for resource-poor countries. SHN program aims to provide timely support and preventive measures to improve the health of school children, which can be associated with their cognitive development, learning, and academic performance. Stakeholders at different tiers can play significant roles in the program implementation and its success. Their perceptions are equally important to provide information on the factors influencing the implementation process and help to identify the gaps in the process. However, the evidence is scarce on the school health and nutrition policy and program implementation in developing countries. No study has yet explored stakeholders' perceptions on the SHN program implementation process in low-income countries, including Nepal. Therefore, we conducted a qualitative study to explore (1) the SHN program implementation, (2) its impact, and (3) challenges in Nepal.

Methods

We conducted a qualitative study through 32 in-depth interviews of the key informants who were actively involved in SHN program implementation in Nepal. The key informants were identified through personal network and snowballing procedure. We adopted a thematic approach for the data analysis.

Results

We categorized interview data into three broad themes: (1) SHN program implementation, (2) its impact, and (3) challenges during implementation. Almost all the key informants appreciated the program for its positive impact on students, schools, and communities. The positive impacts included improved students' health and school environment and enhanced community awareness. However, the key impediments in implementing the program included a lack of coordination between stakeholders, lack of resources, limited training opportunities, and doubts regarding the sustainability of the program.

Conclusions

This study provided a deeper understanding of the linkage between the SHN program implementation, impact, and challenges in Nepal. Despite the challenges, all the stakeholders acknowledged that the SHN program had positive impacts on students, schools, and communities. Our findings highlighted that stakeholders from all tiers should coordinate, collaborate, and continue their efforts to effectively implement and expand the program nationwide. Awareness campaigns and advocacy for the program are indispensable to pull more resources from relevant stakeholders.

Understanding Female Students' Needs to Develop Health Promoting School Programme: An Exploratory Qualitative Analysis

Background

This study was carried out on Iranian female adolescents to understand health needs for the purpose of designing health promoting intervention in schools.

Methods

In this exploratory qualitative study, two focus group discussion (15 teachers) and 30 individual in-depth interviews were conducted among female adolescents in the eighth grade in Zahedan, Iran. Qualitative content analysis was used for data evaluation.

Results

The views of students and teachers demonstrated nine of needs including: informing students about the schools' health project aims, education and training all dimensions of health with an emphasis on mental health, use of experts in various fields for education from other organisations, employing capable and trusted counselors in schools, utilisation of a variety of teaching methods, activating reward systems for encouraging students' participation in group activities, teaching communication and the ability to establish good relationships with parents and strategies for resolving family conflict, teaching parents and students high-risk behaviours and strategies for handling them as well as reforming wrong attitudes and indigenous sub-culture.

Conclusion

This study found the different needs of Iranian female students compared to other cultures about a health promoting school programme. Therefore, their contribution can provide an insight for formulating policies and intervention in schools.

A study on school health policies and programs in the southeast of Iran: a regression analysis

Background

Investing in adolescent health is one of the most important interventions in the health system. Accordingly, health-promoting schools organize their policies, methods, infrastructures, and activities towards protecting and promoting the health and well-being of the students, teachers, directors, authorities and society as a whole.

Objective

To study the health policies of schools in the southeast of Iran.

Methods

This cross-sectional study was carried out on all governmental high schools (113 schools) which were enrolled by census sampling method in January 2017, in Zahedan, in the southeast of Iran. The study tool was a validated questionnaire about the "School Health Policies and Programs" that was completed by the principals or staff of the schools. Data were analyzed by SPSS version 15, using descriptive statistic and linear regression test.

Results

About one-third of the schools did not have a health educator. Some policies, including annual medical examinations, having a healthy breakfast at school, healthy food supply at lower prices in school buffets, and counseling the students with special conditions in schools were not implemented. The most inter-sectoral cooperation was among the health centers (47.8%). The mean score of health policy implementation in schools was 89.70±11.51. Linear regression analysis demonstrated a significant relationship between type of school (p<0.05) and number of students in schools as well as attendance of a health educator in schools (p<0.001) with health policies.

Conclusions

Despite the implementation of the program in Iran in recent years, there are no clear and identical policies in the schools. Therefore, there is need to establish health policy committees in schools from among staff, teachers, parents, and students. In addition, success of the program requires inter-sectoral collaboration, supporting environmental health and improvement of parents' relationships with the school.

Analysis of Iranian Youth Health Policy: Necessity of Action-oriented Interventions

Background:

Protecting the youth and adolescents' health is considered to be an indicator of health equity. The current study was conducted to analyze health status of the Iranian youth and adolescents, identify service gaps, and design action-oriented interventions.

Methods:

In this study with multimethods design conducted in 2014, first to identify and analyze the current situation, related articles and national and international documents were searched and reviewed. Then, stakeholders' analysis, interviews, group discussion, and analysis of the youth and adolescent health management system were done, and the policy document was drew up in three sections of recognition, orientation, and suggested interventions.

Results:

The most important focus areas of the youth and adolescents' health were identified to be their behavior and lifestyle, less advantaging of primary health care in cities, and high rates of educational dropouts. Considering a responsive national structure to develop and implement a comprehensive and integrated program for educating healthy lifestyles and reducing risky behaviors and focusing on accident prevention as a first priority at the level of impact and planning on risk factors of noncommunicable and communicable diseases related to sexually transmitted infections and AIDS at the outcome-level indicators is a necessity through intersectoral collaboration and community participation strategies.

Conclusions:

Achieving premiere indicators of the Iranian youth health requires political commitment and support of the state, more than ever. To cooperation and utilize the capacity of other sectors to implement the Ministry of Health and Medical Education programs, establishment of the youth health commission is recommended with participation of the main partners.

Lessons learnt from pilot field test of a comprehensive advocacy program to support health promoting schools' project in Iran

Background: Health promoting schools (HPS) project is currently being used in Iran but many challenges still lie ahead. The present study aimed, to test feasibility of implementing a comprehensive advocacy program (CAP) to overcome the obstacles and problems associated with the consummation of school health programs based on the HPS framework.

Methods: This quasi-experimental study was performed through recruiting all schools that were enrolled in the national HPS program and located in Jolfa as the intervention group and all of the schools situated in the East Azerbaijan province as control. In order to collect data, Iranian Ministry of Health’s checklists and external audit guidelines for HPS were utilized. In addition, to plan a CAP required data for coordinating fund raising activities including current rules and regulations regarding implementation of local health promotion interventions were collected.

Results: Findings of the study revealed that the implemented CAP had improved all HPS dimensions’ mean score in the intervention group. The observed change in the pre- and post-test score in the intervention group was significant (P < 0.05). The intervention was also successful in encouraging signing of an agreement among the participated organizations to be committed to pursue the adopted policies in facilitation of progress towards full implementation of the local HPS project.

Conclusion: Commencing changes in the recruited schools’ structure through coordinated multi-level activities is feasible and this must be considered as a priority where contextual determinants exist to motivate progress towards providing healthier educational settings for school aged children in Iran.