The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research

Abstract

The World Health Organization’s Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools’ “core business” by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children’s basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.

Lay Field-worker–Led School Health Program for Primary Schools in Low- and Middle-Income Countries

“…The results of this study reveal the importance of the context in which HPS programs take place while contributing to the evidence that such programs can improve student health outcomes in LMICs. 42 Translating this evidence into effective services that reach underserved children has proved challenging. In most LMICs, there is widespread commitment to school health, with governmental policies in place.…”

Effective School Health Service: A Response to Adolescent Health Needs in Europe

“…[13][14][15][16] A promising avenue is the development of policies aimed at the improvement of the ethos or climate of the school, with an emphasis on connectedness, respect, and a positive view at the pupils achievement and future, all grouped together into the concept of healthpromoting schools. 9,17,18 In other terms, as far as adolescents are concerned, the overall trend is an increase in groupbased preventive interventions and health promotion, and a lessening of screening procedures for conditions that are either not followed up properly or have become less prevalent, or have been already identified.…”

Implementation of health promoting policies through tailored interventions at health promoting schools and municipalities in Latvia

“…2018 The existing evidence from systematic reviews suggests that the health promotion approach implemented at schools may contribute to improving child and adolescent health and promotion of healthy lifestyle factors, such as increasing physical activity and vegetable and fruit consumption and reducing tobacco use [2][3][4][5]. However, the description of information on interventional elements and the implementation context in the studies is limited, causing difficulties in understanding the interventional development process and understanding the learning experience [6].…”