Phases of health promotion implementation into the Scottish school system

Abstract

Schools have been identified as ideal settings for health promotion (HP) among children, adolescents and school staff. Most European countries have established strategies to implement HP into their school system, however, little is known about these national strategies and how effective they have been. School HP implementation concerns processes of adoption, adaptation and operation of a complex intervention into a complex setting. This study analyses the processes that have led to school HP implementation in Scotland from the 1980s until now to identify key factors which facilitated and supported effective implementation. In the tradition of case-study research, 14 interviews with representatives of national and local organizations involved in school health, as well as with school staff were conducted. Furthermore, policy documents, reports and guidelines were collected. The data were analysed following a Grounded Theory approach. Four phases of school HP implementation into the Scottish school system were identified: (i) getting started (1980s-1998), (ii) political will and strategic vision (1999-2001), (iii) national leadership (2002-2008), and (iv) integration and embedding into education system (2008-ongoing). Throughout the phases political will and committed actors, the strategy/tradition to give power to the local authorities and individual schools, and the establishment of partnerships and ownership have supported implementation. Scotland is an interesting case giving important insights into the ways and possibilities of negotiating an interdisciplinary and cross-sectoral theme such as HP in schools. Further research concerning different political systems and national implementation processes is important to widen the understanding of national implementation strategies of school HP.

From recipients to partners: children in malaria education in Uganda

“…The barriers faced during the implementation of the school health program in this enquiry stemmed from two aspects: inadequate preparation and planning on the part of the schools; and inadequate collaboration from stakeholders. Implementing school health programs can be an overwhelming task if the schools are not well-prepared (Dorris and Barry, 2013;Gugglberger and Inchley, 2012). It is unrealistic for ill-prepared schools to be expected to undertake this task easily.…”

School development in Austria and implementation factors for health promotion

“…While the choice to adopt a health-related topic is still a decision made by the particular school, there is a demand from a hierarchically higher level to engage in planning and to follow a certain development plan over a number of years. It can therefore be argued that this is a more top-down approach.While many HP programmes are based on the voluntary commitment of the schools, more top-down approaches have also been shown to be successful in implementing school HP (Gugglberger and Inchley 2012).…”

Providing context to the implementation of health promoting schools: A case study

“…Although all school districts have developed their own regional plans to support HPS among schools variability in professional assistance across the province may limit the overall potential of HPS. Specifically, establishing a provincially-based system to support HPS development in NS is an important policy implication that could help to progress adoption, implementation and sustainability of HPS (Gugglberger, 2011;Gugglberger & Inchley, 2012;McIsaac et al, 2014. Fostering collaboration between health and education sectors would further develop an understanding of the mutual benefit between health and educational outcomes; this might be an especially important 'selling' point from the perspective of the education system (Mohammadi et al, 2010).…”

“…The pillars vary depending on the framework adopted in the specific jurisdiction (i.e., HPS, comprehensive or coordinated school health) (Veugelers & Schwartz, 2010) but the overarching emphasis of these initiatives focus on supportive policies and environments, alignment between curricula and involvement from the community (International Union of Health Promotion and Education, 2009). School jurisdictions internationally have developed policies and guidelines to support adoption of HPS approaches across schools (Denman, 1999;Gugglberger & Inchley, 2012;Tang et al, 2009;Veugelers & Schwartz, 2010); however, achieving and sustaining system-wide implementation continues to pose a challenge to advancing this field of work (Mohammadi, Rowling, & Nutbeam, 2010).…”