Background A community-based approach can be a promising strategy for implementing school-based health promotion aimed at stimulating healthy physical activity and dietary behaviour. Such an approach builds on the community capacity of multiple stakeholders, empowering them to design and implement tailored activities, supported by the whole school community. This paper describes the background and evaluation design of the community-based school intervention ‘Fit Lifestyle at School and at Home’ (FLASH) in four prevocational schools. FLASH includes four strategies for building the community capacity of students, school personnel and parents: 1) identifying leaders in each stakeholder group, 2) stimulating a school culture of participation, 3) having stakeholders design and implement tailored activities and 4) creating a network of local partners for structural embedding. The objective is to monitor the capacity-building processes of the FLASH intervention and to explore if these processes contribute to changes in community capacity. In addition, we will explore if the FLASH intervention is related to changes in PA, dietary behaviours and BMI of students. Methods This study has a mixed methods design and uses a participatory action-oriented approach to monitor and evaluate changes in community capacity, tailored health-promotion activities and implementation processes. Methods include semi-structured interviews, focus groups, journals, document analysis and observational scans of the physical environment. In addition, changes in BMI, physical activity and dietary behaviours of prevocational students will be explored by comparing the four intervention schools to four control schools. Data are collected by questionnaires and anthropometric measurements. Discussion The main strength of this study is its use of mixed methods to evaluate real-life processes of creating a healthy-school community. This will provide valuable information on capacity-building strategies for the structural embedding of health-promotion activities within school settings. The results could help schools become more empowered to adapt and adopt integral health-promotion interventions in daily practice that suit the needs of their communities, that are expected to be sustainable and that could lead to favourable changes in the PA and dietary behaviour of students. Trial registration ISRCTN67201841 ; date registered: 09-05-2019, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-019-7088-3) contains supplementary material, which is available to authorized users.

Adolescent boys living in disadvantaged communities are considered a vulnerable group at risk for developing obesity and associated health problems, such as cardiovascular disease, hypertension and type-2 diabetes. While short-term health promotion programmes often produce effective results during the implementation of the intervention, according to self-determination theory (SDT), changes in autonomous motivation are required if programmes are to have sustained effects on health behaviours. This article describes the ATLAS (Active Teen Leaders Avoiding Screen-time) programme, based on SDT, which was developed to engage adolescent boys from low socio-economic backgrounds in physical activity, reduce their consumption of sugar-sweetened beverages and limit recreational screen-time. The article reports a post-hoc analysis of the perceptions and experiences of a representative group of ATLAS participants to investigate whether the boys’ general impressions of the programme reflected the need-supportive teaching strategies on which the programme was based. The results of this analysis suggested that students’ comments about increased feelings of autonomy, competence and relatedness were often linked to corresponding need-supportive teacher behaviours. The findings suggest that embedding health promotion programmes in a need-supportive context can help to foster the motivation and self-regulation that is required to maintain newly adopted healthier behaviours.

BackgroundBuilding community capacity in secondary schools is a promising strategy for the sustainable implementation of school-based health promotion. The Fit Lifestyle at School and at Home (FLASH) intervention explored how building community capacity works for the prevention of overweight following four strategies: leadership, participatory school culture, tailored health-promotion activities, and local networks. This study evaluates the intervention's impact on community capacity and capacity-building processes over a period of 3 years, as well as its effects on adolescents' BMI and waist circumference.MethodsA mixed-methods design guided by the RE-AIM framework was used. Impact on community capacity was evaluated with semi-structured interviews at the start and end of the intervention and analyzed using an anchored coding scale. Capacity-building processes were evaluated using interviews, journals, questionnaires, and the minutes of meetings. The effects on BMI z-scores and waist circumference were evaluated using a quasi-experimental design comparing an intervention (IG) and reference group (RG), based on multi-level analyses.ResultsCommunity capacity improved across all intervention schools but varied between capacity-building strategies. Leadership recorded the greatest improvements, aided by the appointment of Healthy School Coordinators, who increasingly focused on coordinating processes and fostering collaborations. Participatory school culture also improved through the adoption and implementation of participatory methods and a general increase in awareness concerning the importance of the Healthy School approach. Although additional health-promotion activities were implemented, stakeholders struggled with tailoring these to the specific dynamics of their schools. Limited improvements were observed in setting-up local networks that could help schools encourage healthy behavior among pupils. Differences in BMI z-scores between IG and RG over the total sample were negligible whereas waist circumference increased slightly more in IG (0.99 cm, 95% CI [.04; 1.93]). However, differences were inconsistent over time and between cohorts.ConclusionsThis study highlights the potential of building community capacity. It emphasizes that this is a process in which stakeholders must become acquainted with new leadership roles and responsibilities. To navigate this process, schools need support in improving communication, establishing local networks, and sustaining capacity-building efforts in school policy.Trial registrationISRCTN67201841; date registered: 09/05/2019, retrospectively registered.

Background: To sustainably implement a healthy school community in which stakeholders, including pupils, feel ownership over health-promotion activities, building community capacity is important. Pupils have experiential knowledge that is complementary to professional knowledge, but their perspectives on capacity-building processes are underexposed. This study aims to explore secondary-school pupils' perceptions about key influencers on physical activity and dietary choices and starting points for building community capacity.Methods: Seven focus groups with forty one pupils were held in four secondary schools engaged in a capacity-building intervention. Transcripts were analysed thematically regarding key influencers about choices in the home and school setting and capacity-building strategies (leadership, participation, tailored health-promotion activities and local networks).Results: Parents remained important influencers for making healthy choices, but snacking choices were increasingly made independently from parents based on attractiveness, availability and cost. Choices to engage in physical activity depended on social aspects and opportunities in the physical environment. Pupils considered their influence over the healthy school community limited, desired more involvement, but require this to be facilitated. They identified leaders mainly within formal structures, for example, student councils. They believed health-promotion activities related to the physical environment and project-based activities within the curriculum have the maximum potential to stimulate healthy behaviours in school communities.Conclusion: This study shows that pupils can reflect critically on their physical activity and dietary choices, and on how this can contribute to processes in creating a healthy school community. In order to take an active role, they need to be considered as full partners and leadership roles should be facilitated in existing structures.