Background: Although principles of the health promoting school (HPS) approach are followed worldwide, differences between countries in the implementation are reported. The aim of the current study was (1) to examine the implementation of the HPS approach in European countries in terms of different implementation indicators, that is, percentage of schools implementing the HPS approach, implementation of core components, and positioning on so‐called HPS‐related spectra, (2) to explore patterns of consistency between the implementation indicators across countries, and (3) to examine perceived barriers and facilitators to the implementation of the HPS approach across countries. Methods: This study analyzed data from a survey that was part of the Schools for Health in Europe network's Monitoring Task 2020. The survey was completed by HPS representatives of 24 network member countries. Results: Large variations exist in (the influencing factors for) the implementation of the HPS approach in European countries. Observed patterns show that countries with higher percentages of schools implementing the HPS approach also score higher on the implementation of the core components and, in terms of spectra, more toward implementing multiple HPS core components, add‐in strategies, action‐oriented research and national‐level driven dissemination. In each country a unique mix of barriers and facilitators was observed. Conclusion: Countries committed to implementing the HPS approach in as many schools as possible also seem to pay attention to the quality of implementation. For a complete and accurate measurement of implementation, the use of multiple implementation indicators is desirable.
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Introduction: The health-promoting school (HPS) approach was developed by the World Health Organization to create health promotion changes in the whole school system. Implementing the approach can be challenging for schools because schools are dynamic organizations with each a unique context. Many countries worldwide have a health promotion system in place in which healthy school (HS) advisors support schools in the process of implementing the HPS approach. Even though these HS advisors can take on various roles to provide support in an adaptive and context-oriented manner, these roles have not yet been described. The current study aims to identify and describe the key roles of the HS advisor when supporting schools during the dynamic process of implementing the HPS approach. Methods: The study was part of a project in which a capacity-building module was developed for and with HS advisors in the Netherlands. In the current study, a co-creation process enabled by participatory research was used in which researchers, HS advisors, national representatives, and coordinators of the Dutch HS program participated. Co-creation processes took place between October 2020 and November 2021 and consisted of four phases: (1) a narrative review of the literature, (2) interviews, (3) focus groups, and (4) a final check. Results: Five roles were identified. The role of “navigator” as a more central one and four other roles: “linking pin,” “expert in the field,” “critical friend,” and “ambassador of the HPS approach.” The (final) description of the five roles was recognizable for the HS advisors that participated in the study, and they indicated that it provided a comprehensive overview of the work of an HS advisor in the Netherlands. Discussion: The roles can provide guidance to all Dutch HS advisors and the regional public health organizations that employ them on what is needed to provide sufficient and context-oriented support to schools. These roles can inspire and guide people from other countries to adapt the roles to their own national context.
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Background: The environment affects children’s energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention. Methods: A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data. Discussion: Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used.
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