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Evaluation of Health Promoting Schools Programme in Saudi Arabia
... Very few studies have been conducted to assess the Health-Promoting School framework in Saudi Arabia. A survey by Alzahrani [25] looked into the progress and experiences in implementing Health-Promoting Schools across Saudi Arabian regions. The key findings of the survey emphasized the significant increase in the number of schools that implemented the Health-Promoting School framework. ...
The Health Promoting School (HPS) is a WHO sponsored framework, compiled to enable education and health sectors to be more effective in school based initiatives.
This study attempted to test the hypothesis that students from schools that had comprehensively embraced the HPS concept as indicated by the Healthy School Award, were better, in terms of health risk behaviour, self reported health status, and academic results, than students from schools that did not reach the standard of the award.
The results presented came from nine schools (four primary and five secondary) applying for accreditation of the Healthy Schools Award after adopting the HPS framework for two years. Regular consultancy support and training were available to all schools. Students had completed before and after surveys to assess their health behaviours, self reported health status, and academic standing before the two year intervention, and at its end. Data from the before and after surveys of the students attending schools that reached certain level of HPS standard as indicated by the award, were compared with students whose schools did not receive the award, and the results showed differences. Some differences were found to be more significant among the primary school students than secondary schools students. This illustrated early intervention for lifestyle changes to be more effective. Students' satisfaction with life also improved if their schools adopted the concept of HPS comprehensively.
The results suggest that comprehensive implementation of HPS would contribute to differences in certain behaviours and self reported health and academic status.
This paper presents a holistic model of the health promoting school and a panoramic framework for evalution. The framework is board, acknowle dging the range of national settings in which health promoging schools are being developed, and draws attention to the emphasis on context and process rather than outcomes. The conceptual model is applied to the European Network of Health Promoting Schools (ENHPS), where the same forces may be at work in relation to the innovation but operate in different ways and with different degrees of strength. The paper recommends a selective approach to evaluation which will serve specific audiences and decision making needs.
The qualitative research process is presented and discussed as a model, emphasizing matters frequently experienced as unfamiliar by the medical researcher. This model represents a prescriptive methodology, implying underlying values on construction of scientific knowledge where shared understanding--intersubjectivity--is considered as essential. Various stages of the research process are demonstrated, drawing attention to matters that influence analysis and the paths to knowledge, especially preconceptions and theoretical frames of reference. Principles and procedures related to analysis of qualitative data, as decontextualizing and recontextualizing, are explained. The structure of this model, accentuating the researcher's responsibility to give access to all levels of the research process, underlies all kinds of scientific inquiry. Such principles should probably more often be explicitly questioned and accounted for in all sorts of medical research.
The concept of the 'Health Promoting School' has been widely advocated as an approach to enhancing public health through school based health promotion. In many areas 'Healthy Schools Award' schemes have been set up to support the development of this concept, but there is no information on how widespread this practice is in the UK, how standards are evaluated, and what effect Healthy Schools Awards may have on young peoples' health. This UK national survey aimed to determine the extent and nature of existing award schemes and how they were being evaluated. A postal questionnaire was sent to all 200 health promotion units in the UK; the response rate corrected for mergers of units was 78.5%. Sixty-eight respondents (51%) were involved with an award scheme and 28 (21%) were planning them. Current award schemes were mostly jointly run by the health and education sectors, encompassing 845 participating schools of which two-thirds were primary schools. The most common issues addressed were; standard chronic disease risk behaviour, the environment and health education in the national curriculum; less frequently addressed were mental health, accident prevention, staff health and developing links with the wider community. Evaluation was usually by target setting and assessment of progress over a two year period. However, evaluation was rarely external or independent, raising doubts about the standards obtained and validity of the approaches. This survey highlights the rapid growth of healthy schools award schemes and the need for wider exchange of information on good practice. In particular there is a need for more explicit and measurable standards of achievement to ensure the quality of award schemes, and further research into their effectiveness.
Schools are identified as a key setting for health promotion in the UK Government's consultation report on the public health
strategy for England. The concept of the 'healthy' or 'health promoting school' provides the basis for a broad settings approach
to health promotion in schools. The approach extends beyond the formal health education curriculum to include a consideration
of the physical and social environment of schools and their links and partnerships with parents and the wider community, in
pursuit of better health. There is growing evidence that the health promoting school approach is effective in influencing
outcomes related to health and education. Initiatives in the form of projects and schemes are commonly used by Health Promotion
Specialist services and health partnerships, to stimulate and support the adoption of the approach by schools. A national
healthy school scheme is to be launched alongside these local initiatives in 1999. The paper reviews research and practice
in this area and makes recommendations to inform the future development of schools as health promoting organizations.
Keywords: health promoting schools, concept, evidence, development
Objectives: The objectives of this study were to: evaluate the effectiveness of school-based health promotion interventions through: - a systematic review of primary studies of the effectiveness of the health promoting schools approach - a systematic review of existing reviews of the effectiveness of other health promoting interventions in schools in the following areas: nutrition, exercise, safety, psychological aspects of health, sexual health, substance use, personal hygiene, environmental issues and family life education indicate areas where further research is needed make recommendations for practice in the UK, if research findings permit. Methods: Study selection To be included in the review of the effectiveness of the health promoting schools approach, studies had to: be controlled studies or before-and-after studies evaluating school-based interventions involving health promoting activity in each of three areas: (i) the school ethos and/or environment, (ii) the curriculum, and (iii) the family and/or community; and demonstrate active participation by the school provide information about the components and delivery of the intervention report all evaluated outcomes. To be included in the review of existing reviews of health promotion in schools, reviews of effectiveness of health promotion interventions in schools had to: provide evidence of a systematic search assess the quality of the research include some studies with a comparison group or some before-and-after studies report study details such as number of participants, give some details of the content of the interventions evaluated and include primary preventive interventions using a population approach. Data sources: The following electronic databases were searched: ASSIA, BIDS, British Education Index, CINAHL, DHSS Data, Dissertation Abstracts, EMBASE, ERIC, MEDLINE, PsycINFO, PsycLIT, SIGLE, Sociofile. Reference lists were checked to identify other relevant studies, relevant web pages were scanned, and requests for unpublished data were made to people working in the field. Data extraction: Data were extracted by one reviewer, using a pro forma, and checked by a second reviewer. The methodological quality of both primary studies and reviews were assessed and commented upon. Data synthesis: A quantitative synthesis was judged impractical due to the multiplicity of outcomes and incomplete reporting of all the components of the interventions. A qualitative synthesis is presented. Results: Review of primary studies of the health promoting schools approach The search identified 1067 titles and abstracts relevant to health promoting schools. Of these, 111 appeared to be either useful background material or evaluations of interventions and were obtained. Twelve studies met the inclusion criteria. Available evidence of effectiveness Few studies were available for this review, and only two of these were adequately powered randomised controlled trials. None of the schools involved in the studies had implemented all the components of the health promoting schools approach. The evidence available to support the health promoting schools approach was limited but promising. The approach can be shown to impact on the social and physical environment of the school in terms of staff development, school lunch provision, exercise programmes and social atmosphere. Although failing to demonstrate effectiveness in all studies, the approach was successful in some in improving aspects of health- related behaviour such as dietary intake and aspects of health such as fitness. There is some evidence that this approach is able to impact positively on aspects of mental and social well-being such as self-esteem and bullying, which have previously proved difficult to influence. Costs: Insufficient information was given to be able to comment on relative costs, but in the UK study of health promoting schools a small financial investment in schools was considered important for success. Theoretical bases of effective interventions: Although the interventions tested in these studies clearly drew implicitly on a number of health promotion theories, the theory base was explicitly stated for only two interventions. Review of reviews of health promotion in schools: Over 200 reviews of the effectiveness of school health promotion were identified. Of these, 32 met the inclusion criteria. Available evidence of effectiveness: Systematic reviews of effectiveness are available in the following areas: nutrition and exercise, safety, psychological aspects of health, sexual health, substance use and personal hygiene. Most of the studies included in the reviews originated from outside the UK; mostly from North America. Reviews varied in their methodological quality. Almost all the interventions, for which this outcome was reported, demonstrated improved health knowledge, which is an important prerequisite for future health. The impact of interventions on attitudes, health-related behaviour and health was much less reliable. Some effective or partially effective interventions have been identified in most areas, but many were ineffective, and a few were shown to have adverse effects. Interventions to promote healthy eating and fitness, prevent injuries and abuse, and promote mental health were the most likely to be effective and those to prevent substance misuse, promote safe sex and oral hygiene the least effective. Effectiveness of different approaches: Most interventions have used classroom (curriculum) approaches only. Some interventions combined a classroom approach with changes to the school ethos and environment or with family and community involvement. Although the environmental approaches varied in the different areas of health need, interventions which included these approaches were more likely to be effective that those which did not. Interventions involving families varied in intensity and approach and in many reviews were inadequately described, but overall interventions incorporating this approach were more likely to be successful than those that did not. Effective components of classroom approaches: Assessment of the effectiveness of different components was limited by inadequate reporting of intervention content. Against a background of relative ineffectiveness there is evidence that substance use programmes incorporating normative education and resistance skills were more likely to be effective than those which did not. Programmes involving peers were most common in substance misuse reviews. They varied in approach and intensity, and in some studies were inadequately described. Substance misuse interventions incorporating this approach were, however, more likely to be effective than those which did not. There was evidence that stress management and life skills training had a positive impact in interventions addressing psychological aspects of health. Theoretical bases of effective interventions: Reviews often failed to report explicitly the theoretical basis of interventions. From the very limited evidence available there are indications that programmes based on social learning theory and social influences are the most effective. Conclusions: The health promoting schools approach: The health promoting schools initiative is a new, complex, developing initiative, and the optimum method of evaluation is currently under debate. There are indications that this approach is promising. The development of programmes to promote mental and social well-being would be likely to improve overall effectiveness and the impact of staff health and well-being needs more consideration. The development of measures of mental and social well-being is important for future evaluation. Continued investment, and ongoing evaluation are necessary to provide evidence about the effectiveness of this approach. Health promotion in schools: This review of reviews has shown that school health promotion initiatives can have a positive impact on children's health and behaviour but do not do so consistently. It would appear that most interventions are able to increase children's knowledge but that changing other factors which influence health, such as attitudes and behaviour, is much harder to achieve, even in the short-term. Overall, a multifaceted approach is likely to be most effective, combining a classroom programme with changes to the school ethos and/or environment and/or with family/community involvement. This is consistent with the health promoting schools approach.
This paper describes the evaluation of a health promoting schools intervention carried out in the south western region of Sydney, Australia. The evaluation sought to assess the project's impact on structures to support the health promoting school concept and changes in health-related policies and practices within 22 local schools.
A randomised controlled study was employed. Intervention schools were offered seminars and training in the health promoting schools concept, encouraged to use a resource kit to help them establish their school as health promoting and invited to participate in a support network. Pre- and post measures of awareness, school structures and policies and practices to support the development of a health promoting school were taken and intervention and control schools compared.
There was an increased level of awareness of the health promoting school concept among intervention schools. However, there were no significant changes in health-related policies and practices at the school level, among both intervention and control schools.
A longer time frame and more structured support are required to influence school structures to support the development of a health promoting school.
To facilitate organisational change in schools, health promoting school interventions need to provide structured support for schools and recognise that change takes time. A committee to initiate action, a plan to guide work and school support are likely to facilitate the adoption of the health promoting schools approach. Further work to refine the measurement of school-based action and its outcome and the development of indicators for a health promoting school is needed.
No detailed analyses have been undertaken on the effects of Health Promoting Schools on oral health status. The objective of this study was to assess whether the oral health of 12-year-old children in supportive schools, where health promoting policies had been developed, was better than that of children in non-supportive schools. A sample of 1823 12-year-old children in 33 public (government-funded) schools were selected in deprived areas of Curitiba, Brazil. Principal component analysis, multiple regression, meta-analysis and meta-regression were used in the data analysis. Schools with a comprehensive curriculum were more likely to have a higher percentage of caries-free children (beta = 6.27, p = 0.02) and fewer children with dental trauma (beta = -5.04, p = 0.02). The commitment towards health and safety at school was strongly associated with dental trauma, as 9.7% fewer children had dental trauma (p = 0.00) in schools that demonstrated a commitment towards health and safety. At the school level, mother's education and family income were independently associated with children's caries experience and dental trauma, respectively. Children in supportive schools had better oral health than those in non-supportive schools. Our results suggest that some benefit can be obtained for the improvement of the oral health of children living in deprived areas if they attend supportive schools.
The Health Promoting School (HPS) and Comprehensive School Health Program (CSHP) initiatives have been proposed as a means of going beyond some of the limitations associated with health promotion initiatives aimed at school-aged children. This involves moving beyond practices that rely mainly on classroom-based health education models, to a more comprehensive, integrated approach of health promotion that focuses both on child-youth attitudes and behaviors, and their environment. Despite the tremendous potential of these initiatives in terms of health and educational gains, only rarely are they actually put into practice. This article briefly reviews the features of these initiatives, as well as the extent of their implementation and current benefits. Against that backdrop, the authors identify some issues to consider and propose four conditions with a view to achieving broader practical application of these approaches. These issues, which are discussed from the standpoint of potential avenues of further study and courses of action, relate to the comprehensive, integrated nature of the intervention, the school/family/community partnership, political and financial support from policy makers, and, finally, evaluative research as a support to implementation.
The objective was to assess the prevalence and factors associated with Traumatic Dental Injuries (TDI) to anterior teeth of 11-13 year old Thai children.
A cross sectional survey was carried out in a sample of 2,725 children from 52 primary school classes in the Chiang Mai urban area of Thailand. The children were clinically examined for TDI and interviewed.
35.0% of children experienced TDI. Males (45.3%) had TDI levels approximately twice as high as females (25.2%), and the prevalence of TDI increased with age. TDI were more common amongst children living in more disadvantaged households and whose parents were less educated. Children with an overjet greater than 5mm were also more likely to have TDI. Most of the affected children (20.6%) had trauma to I tooth, 10.3% to 2, 2.6% had 3 teeth affected. The proportion of damaged teeth was 4.6 per 100 anterior teeth. Central incisors were the most common teeth with TDI, both in the upper and lower jaws. Enamel fracture was the major type of TDI. Most of the TDI occurred at home and school. Running was the major activity leading to TDI. 'Falls' was the most common manner causing TDI (24.8%). Ground surfaces (22.4% of all cases), particularly concrete surfaces (14.6% of all cases), were the most common vectors which directly contacted or injured children. Biting hard material was the most common activity leading to TDI.
Traumatic dental injuries are common and are an important dental public health problem in Thailand.
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