Culture matters: a case of school health promotion in Canada

Abstract

SummaryRising concerns of poor health behaviours of children and youth have stimulated international support for a comprehensive approach to promoting the development of healthy behaviours in the early years. Health promoting schools (HPS) is increasingly adopted as an approach to guide supportive practices, but there is limited research that has reported how to effectively implement HPS at a population level. The purpose of this research was to qualitatively explore the factors preventing and facilitating implementation of HPS practices in the Canadian province of Nova Scotia. Interviews (n ¼ 23) were conducted with school stakeholders (principals, teachers and parents) from a diverse sample of schools (n ¼ 9) and data were analysed to develop an understanding of how school circumstances and experiences influenced HPS implementation. At a broad level, the reported barriers were structural and systemic, whereas the facilitating factors were related to organizational capacity and political leadership. It was evident that implementing and sustaining HPS required a shift in values and integration of supportive school health practices into school priorities. The results suggest that, without addressing the competing culture, which is persistently reinforced by strict academic mandates and unhealthy community norms, HPS will be vulnerable to circumstances that prevent implementation. Considering the emerging importance of mental wellbeing, it will also be important to provide schools with adequate and appropriate staff capacity and support to address this issue. Sustaining the positive effects of HPS will require continuous engagement and collaboration with multiple stakeholders to embed health promotion into school community norms.

The impact of school policies and practices on students’ diets, physical activity levels and body weights: A province-wide practicebased evaluation

“…33 A supportive school and community culture was also reported in our qualitative research as a key factor in overcoming barriers to health promotion. 27 It is important to note the potential limitations of our study. The cross-sectional design offered two time points to assess student outcomes before and after policy implementation, but it may take more time for changes in school environments to influence student behaviours, which was beyond the scope of this study.…”

“…These results corroborate the impact of schoollevel barriers reported in our previous qualitative study. 27 The lack of a provincially mandated policy related to PA beyond the curricular requirement for physical education may have negatively influenced implementation at the school level and may help explain the worsening trends in PA among students. It is important to note that, following the 2011 data collection cycle, a provincial childhood obesity prevention strategy (Thrive!…”

“…[30][31][32] Our qualitative research has suggested that competing demands on the school system may limit the adoption of health promotion practices in schools. 27 Schools need to have time and capacity to allow them to move beyond their traditional classroom responsibilities and make sustainable changes to their environment. Providing capacity through the form of a school health facilitator has been shown to be an effective intervention for improving diet, PA and weight status in Alberta.…”

Examining the context of health promoting schools: a translational approach to characterization and measurement of school ethos to support health and wellbeing

“…Some schools may not require all aspects of the HPS approach; perhaps some schools are well resourced, but lack of a consciousness of health that is needed to support a HPSE for a more fully developed HPS approach. As previous research has suggested, each school is unique and reflects the leadership, students, parents and community it serves, creating a large variation in school context that requires careful consideration prior to HPS implementation (18).…”

“…While HPS interventions hold a great deal of promise for supporting the lifelong development of healthy behaviours in children (12)(13)(14), challenges persist in their implementation and evaluation (6,7,15,16). HPS is complex and multifaceted, in part because implementation occurs gradually over time and school practices might develop, innovate or adapt in response to specific policies or contextual factors (17,18). As a result, schools adopting a HPS approach may not fulfill all core principles of the approach.…”