Since the 1980s, schools have been recognized as an ideal setting to promote students' and teachers' health. Three decades after the development of the Health Promoting Schools (HPS) approach, however, there is still only limited knowledge about the implementation of health promotion (HP) activities in this setting. Some studies indicate that schools change original concepts significantly when adapting them to local context in the course of implementation. In this paper, we pursue the question how HP is practiced in schools that have agreed to implement HPS concepts from regional service providers (SPs), using data from a multiple-case study conducted in an Austrian province. Furthermore, we explored the HP activities chosen for implementation and the decision-making leading to their implementation. We draw on 22 interviews with members of the school community and provincial HP SPs, 9 group discussions, and 10 observations we have carried out within three schools between November 2010 and January 2012, supplemented by a variety of documents. We have identified 40 different HP activities, of which most targeted students, while mostly focusing on physical activity and/or psychosocial health. Planning, coordination and cooperation at the school level were minimal. Decisions for or against activities were seldom taken together, but taken individually due to personal knowledge, interests and experiences, perceived needs and problems, already existing activities and external influences. The findings suggest that schools rather remain with a traditional topic-based approach instead of realizing an integrated whole-school approach and indicate a need for more support especially during the early phases of implementation.

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