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Theoretical and empirical base for implementation components of health-promoting schools

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Abstract

Purpose – Efforts to create a scientific base for the health-promoting school approach have so far not articulated a clear "Science of Delivery". There is thus a need for systematic identification of clearly operationalised implementation components. To address a next step in the refinement of the health-promoting schools' work, this paper sets out to delineate implementation components of health-promoting schools and to identify their mechanisms. Design/methodology/approach – The implementation components were identified through a narrative synthesis of documents describing implementation of health-promoting school approaches. Studies were included if they were published between 1995 and June 2010 and could be identified in publicly accessible peer-reviewed articles and grey literature, published in English. Eight sources were extracted, representing reports from all continents with the exception of Africa. Findings – Eight components were identified: preparing and planning for school development; policy and institutional anchoring; professional development and learning; leadership and management practices; relational and organisational support context; student participation; partnerships and networking; and sustainability. Practical implications – The components provide a practical tool/guide for schools to use in the implementation of health-promoting schools. In a parallel paper theoretically and empirically based practice guidelines for the actual implementation of the components are articulated ("Filling the black box of implementation for health-promoting schools", this issue). Originality/value – The identification of specified theory-driven implementation components for health-promoting schools aims will help practitioners to understand the function of each component, so they can execute them with fidelity and thus contribute to rigorous implementation of the health-promoting school initiative.
Theoretical and empirical base
for implementation components
of health-promoting schools
Oddrun Samdal
Department of Health Promotion and Development, Faculty of Psychology,
University of Bergen, Bergen, Norway, and
Louise Rowling
Faculty of Education, University of Sydney, Sydney, Australia
Abstract
Purpose Efforts to create a scientific base for the health-promoting school approach have so far not
articulated a clear “Science of Delivery”. There is thus a need for systematic identification of clearly
operationalised implementation components. To address a next step in the refinement of the
health-promoting schools’ work, this paper sets out to delineate implementation components of
health-promoting schools and to identify their mechanisms.
Design/methodology/approach – The implementation components were identified through a
narrative synthesis of documents describing implementation of health-promoting school approaches.
Studies were included if they were published between 1995 and June 2010 and could be identified in
publicly accessible peer-reviewed articles and grey literature, published in English. Eight sources were
extracted, representing reports from all continents with the exception of Africa.
Findings – Eight components were identified: preparing and planning for school development;
policy and institutional anchoring; professional development and learning; leadership and
management practices; relational and organisational support context; student participation;
partnerships and networking; and sustainability.
Practical implications – The components provide a practical tool/guide for schools to use in the
implementation of health-promoting schools. In a parallel paper theoretically and empirically based
practice guidelines for the actual implementation of the components are articulated (“Filling the black
box of implementation for health-promoting schools”, this issue).
Originality/value – The identification of specified theory-driven implementation components for
health-promoting schools aims will help practitioners to understand the function of each component,
so they can execute them with fidelity and thus contribute to rigorous implementation of the
health-promoting school initiative.
Keywords Health promotion, Schools, Implementation, Fidelity, Whole school, School development,
Learning organizations, Review
Paper type Conceptual paper
Introduction
In the field of school health the introduction of health-promoting schools in the 1980s and
1990s required a paradigmatic shift in conceptualisation and practice. The major change
was from a fairly narrow classroom based health education and the provision of school
health services approach to addressing the school as a setting for improvement of health
and wellbeing, requiring a whole school approach of organisational and systemic change
(Deschesnes et al., 2003). A whole-school approach to health promotion may include
The current issue and full text archive of this journal is available at
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Theoretical and
empirical base
367
Received April 2010
Revised September 2010
Accepted December 2010
Health Education
Vol. 111 No. 5, 2011
pp. 367-390
qEmerald Group Publishing Limited
0965-4283
DOI 10.1108/09654281111161211
classroom based health education, for instance through the use of pre-packaged
programmes. In addition it gives emphasis to the involvement of the stakeholders in
school (students, teachers, parents and local community) in identifying needs as well as
in implementation of actions to meet the needs (Lister-Sharp et al., 1999; St. Leger, 2000;
Stewart-Brown, 2006; Cushman, 2008; Samdal, 2008). This has prompted many countries
in the last 20 years to implement whole school health promotion actions that have as a
common base a contextual or socio-ecological approach to health (McLeroy et al.,1988),
conceptualised as health-promoting schools or healthy schools (Kickbusch, 2003).
Creating a scientific base for the health-promoting school approach has been an
important process in the last two decades of work. There have been three major
endeavours in this process. First, establishing the rationale for this approach
primarily by linking health and learning (see Clift et al., 2005; Rowling and Jeffreys,
2006); second, producing guidelines articulating the principles of health-promoting
schools (see www.schoolsforhealth.eu; ENHPS, 1997; IUHPE, 2008, 2009; Tang et al.,
2009); and third, providing indicators to assess if activity was meeting the guidelines
(see Lee et al., 2005; Barnekow et al., 2006; Wicklander, 2006).
This previous work attempted to stimulate the development of a health-promoting
school. However it has a major gap in that it has not articulated a “Science of Delivery”
(Catford, 2009), through systematically identifying empirically and theoretically based
components of quality implementation, to create health-promoting schools.
Components are needed that propose “models that can be put into practice in
natural contexts” (Deschesnes et al., 2003, p. 393). Given that health promotion in
schools has been ongoing since the 1980s there are surprisingly few studies on the
implementation of health-promoting school actions.
To ensure efficient implementation of the health-promoting school approach there is
thus a need to identify how the approach can best be implemented. This can be done by
building on scientific knowledge of implementation theory as well as empirically based
practice from health-promoting school initiatives (Tang et al., 2009).. Systematic
identification and provision of clearly operationalised implementation components will
allow practitioners to understand the function of each component so they can execute
them with fidelity (Dusenbury et al., 2003). To address a next step in the refinement of
health-promoting schools’ work, this paper sets out to delineate a theoretical and
empirical base for implementation components of health-promoting schools. The
empirical delineation of core implementation components for health-promoting schools
will be based on a literature review. Relevant implementation and organizational
change theories will be used to identify the functionality, i.e. the mechanisms at work,
for each component. In a parallel paper theoretically and empirically based practice
guidelines for the actual implementation of the components are articulated (“Filling the
black box of implementation for health-promoting schools”, this issue).
Theoretical and empirical base
Implementation can be conceived in a range of ways from representing the act of
delivering an intervention to preparing and equipping an organisation to change its
practice by providing guidelines and tools (Guldbrandsson and Bremberg, 2006).
Fixsen et al. (2005) in their comprehensive review of implementation research define
implementation as a specified set of activities designed to put into practice an activity
or programme of known dimensions.
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Recently developed intervention standards for school-based programmes
(Ferrer-Wreder et al., 2004) emphasise the need for greater use of theory not only in
the development of interventions but also for their implementation. Implementation
theory needs to be made explicit so that practitioners know which implementation
policies and practices they should employ to implement the intervention components
with fidelity (Weiner et al., 2009). In health-promoting school research, there has been a
limited focus on the articulation of policies and practices for implementation
(Deschesnes et al., 2003). This makes it difficult both to implement and evaluate the
effectiveness of the approach (Dooris, 2006).
Generic implementation theory and research may be a first important step to help
identify core implementation components for health-promoting schools. Reviews of the
field of implementation in organisations have identified a range of components that need
to be attended to. Most of the reviews that address schools focus on implementation
components of pre-packaged intervention programmes aiming at changing student level
behaviours (Fixsen et al., 2005; Stith et al., 2006; Durlak and DuPre, 2008: Forman et al.,
2009). However, these implementation components may not be sufficient for the
health-promoting school approach as this requires organizational and contextual change
to meet its principles and aims (Weiner et al., 2009). From its very beginning, the
health-promoting school approach highlighted the importance of building a supportive
environment in school to stimulate students’ health behaviours, health, and well-being
(Parsons et al., 1996; St. Leger, 2000). While a school-based pre-packaged program
frequently is implemented in the classroom by individual teachers, a health-promoting
school approach, like all setting approaches, involves a complex dynamic of group
behaviours and system changes within the school and in collaboration with external
stakeholders (Whitelaw et al., 2001; Deschesnes et al., 2003).Thus the health-promoting
school approach introduced a shift from individual behaviour orientation to a
socio-ecological approach, emphasising the interplay between organisations and
individuals (McLeroy et al., 1988; Deschesnes et al., 2010a). This interplay requires
change at organizational level before expecting to achieve change at individual level
(Green and Kreuter, 2005).
To accommodate organizational change in school, Daft (1999) has identified three
core implementation strategies:
(1) providing direction in line with overall school aims and visions;
(2) aligning teacher and school efforts to achieve commitment towards an
intervention; and
(3) enabling the school to conduct the needed actions through resource and time
allocation, and professional development.
The first strategy identifies to what extent the values of the innovation fit with the
overall values and aims of the school. This has been classified as a prerequisite or
confounder of implementation success (Weiner et al., 2009). Daft’s second strategy
more closely matches the concept of readiness; i.e. to prepare an organisation and the
participants for their participation in implementation action. This preparation is to
ensure their awareness and understanding of the change process as well as their
motivation and commitment to achieve its aims (Elias et al., 2003; Weiner et al., 2009).
The third strategy could be seen to more specifically address policies and practices for
the actual change process in school in terms of fiscal and human resources as well as
Theoretical and
empirical base
369
development of individual and organisational capacity and competence to participate
in and conduct the change process.
Although there is an overlap between the factors needed for implementation of
pre-packaged programmes (Fixsen et al., 2005; Stith et al., 2006; Durlak and DuPre,
2008; Forman et al., 2009), the implementation strategies identified by Daft (1999) to a
larger extent emphasise the importance of taking organisational level values, capacity
and needs into account in the implementation process. A core issue of implementation
theories/research is the facilitation of a stimulating socio-ecological interplay between
systems and individuals in terms of building supportive culture and structures for
implementation practices (Greenhalgh et al., 2004; Wandersman, 2009). This interplay
is present in Daft’s suggested strategies and therefore makes it a viable perspective to
use when aiming at identifying implementation components for health-promoting
schools (Deschesnes et al., 2010a).
Building on the current research-based knowledge of implementation strategies for
organizational change, this paper aims to identify and conceptualise specific
implementation components for health-promoting schools. The identification of the
implementation components will be derived from a literature review of empirical
studies of implementation of health-promoting school initiatives. The
conceptualisation of the components is informed by employing relevant
organizational change theories. A core aim of the conceptualisation is to articulate
the content and the working mechanisms of each component, i.e. providing, both the
“what” of the component and the rational for “why” the component is needed.
Methodology
The current study employs a narrative review process, including the following stages
(Mays et al., 2005):
(1) Defining the underlying purpose or aim of the review.
(2) Specifying the review question/s.
(3) Scoping the review and mapping the evidence.
(4) Deciding on criteria and selecting the studies.
(5) Data extraction and study quality appraisal.
(6) The synthesis.
(7) Reporting the results of the overview and dissemination.
In the process adopted in the narrative synthesis reported here, the problem identified
was the gap in research-based knowledge of implementation of health-promoting
schools. The aim of the process therefore was to identify the content of action (the what
of the components) as well as develop a theoretically based rationale (the why) of each
component. Questions that guided the review included: What detail is there about
implementation? and Is there a focus on specific areas for implementation that have a
theoretical base?
The literature review was based on searches of available English-language
literature documents/book chapters/empirical reports via ERIC, PubMed,
Web-of-Knowledge and Google Scholar. Key words included: health-promoting
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schools, implementation, comprehensive approach, whole school improvement/change,
school health promotion.
Studies were selected for review if they were published between 1995 and 2010 and
if they delineated implementation of health-promoting schools or addressed an
educational change process that focussed on health. To meet delineation criterion
descriptions had to include more than a list of strategies. They had to articulate actions
that could be replicated. Further, the studies needed to provide a clear description of
sample, data collection and findings to be considered for review. Studies were not
included if they only encompassed the implementation of a pre-packaged programme,
not contextualised in a socio-ecological health promotion approach. The decision to
exclude implementation of pre-packaged programmes was made as these mainly focus
on the extent the implementation of an existing intervention is fulfilled (fidelity,
dosage, quality, participant responsiveness and programme uniqueness) not how it
was implemented in the classroom and school.
The initial search was done in the Web-of-Knowledge database and gave a total of
556 hits. Of these only five papers addressed identification of implementation factors
for health-promoting schools. Similar searches were conducted using the databases
ERIC and PubMed, but no further papers were identified. An advanced search in
Google Scholar provided thousands of hits. The first 100 hits were checked, in which
two additional sources were identified. Another source was known to be in press at the
time and was directly identified by the authors. Through this process a total of eight
sources were extracted.
The initial sorting involved both authors independently reviewing the documents to
identify if they met the inclusion criteria. Emphasis focused on identifying sources that
described and categorised the process of implementing health-promoting schools. To
qualify as a source of components, articles needed to do more than mention the
importance of a component, they had to articulate that component as integral to
their implementation. Eight sources were identified that specifically detailed
implementation. Importantly five of these were written by health-oriented
researchers and three by education-oriented researchers, demonstrating the cross
disciplinary perspective being utilised by researchers to effectively delineate quality
implementation. Given the scarcity of sources available there was no attempt to
differentiate between different types of studies as long as they provided the type of
information required for the task. Therefore different types of studies were included;
three were studies integrated in evaluations of health-promoting school initiatives
(McBride et al., 1999; Bond et al., 2001; Felner et al., 2001), four were stand-alone process
evaluations (Inchley et al., 2007; Aldinger et al., 2008; Hoyle et al., 2008; Samdal et al.,
2010) and one source was a literature review (Deschesnes et al., 2003).
The narrative synthesis (Mays et al., 2005) utilised the techniques of conceptual
mapping, identifying similarities and differences and a translational process exploring
relationships (Greenhalgh et al., 2004; Popay et al., 2006). Narrative approaches deal
with findings and interpretations in their own terms without transforming them into a
common quantitative grouping. Rather the content of the different terms in each source
are analysed to identify to what extent they overlap with terminology in other sources
(Greenhalgh et al., 2004). The method was chosen to identify implementation
components due to the heterogeneity of focus and practices in the health-promoting
schools reports reviewed.
Theoretical and
empirical base
371
A data extraction tool was developed to provide a framework for the analysis of the
eight articles (Table I). The tool provided a structure for summarizing and detailing the
findings from the studies and reviews about elements of implementation identified in
the narrative synthesis.
Findings
Table I provides key information on the source, reference, keywords, focus of source,
theoretical base/conceptual base of the study, and implementation components
described. The last column provides the result of the narrative synthesis grouping
findings into common terminology across the eight sources. From this synthesis
process eight components were identified:
(1) Preparing and planning for school development.
(2) Policy and institutional anchoring.
(3) Professional development and learning.
(4) Leadership and management practices.
(5) Relational and organisational support context.
(6) Student participation.
(7) Partnerships and networking.
(8) Sustainability.
In the last column of Table I the numbers assigned above are used to highlight which
components each source identified.
The narrative analysis showed some clear patterns. Two components student
participation (component 6) and sustainability (component 8) were only articulated
in three of the sources (Inchley et al., 2007; Aldinger et al., 2008; Samdal et al., 2010),
whereas all articles included preparing and planning for school development
(component 1). However, not all of them acknowledged the need to prepare a school for
implementation as highlighted by Daft (1999). Partnerships and networking
(component 7) were described in seven sources. Policy and institutional anchoring
(component 2), professional development and learning (component 3), leadership and
management (component 4), and relational and organisational support context
(component 5) were all described in six sources. In component 3 both the parts of the
component were not always present. For example Hoyle et al. (2008) were the only
authors to describe the need for professional learning.
Below each of the components will be presented in more detail. To meet the aim of
the paper to identify a theoretical and empirical base for implementation components
for health-promoting schools, a theoretical rationale for each component will be
outlined building on the source literature as well as generic implementation and
organizational change theory.
Preparing and planning for school development
A key priority identified in many sources was the need for preparing for school level
change and development. (McBride et al., 1999; Bond et al., 2001; Deschesnes et al.,2003;
Inchley et al., 2007; Aldinger et al., 2008; Samdal et al., 2010). Preparing for a
health-promoting school approach requires focus on programme theory or programme
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Source Focus of article
Theoretical/conceptual
base
Terminology of components used
in the sources
Proposed common terminology
for implementation components
Aldinger et al., 2008
Keywords:
Health-promoting schools,
School health, China
A report of national
implementation of health-
promoting schools (scaling
up previous pilot phase)
Health-promoting schools
Implementation theory
(a) Pre-implementation (entry
point, committee, work plan)
(b) Implementation (mobilization,
prioritizing, popularizing,
community participation, role
modelling, training, new
teaching and learning methods
(c) Monitoring and evaluation
(process and outcome, holistic
approach)
(1) Preparing and planning
(2) Policy and institutional
anchoring
(3) Professional development and
learning
a
(4) Leadership and management
(6) Student participation
(7) Partnerships and networking
a
(8) Sustainability
Bond et al., 2001
Keywords: School change,
School environments, Capacity
building, Health promotion,
Student engagement, Student
wellbeing, Gatehouse project
Empirical report on
Australian program to
promote student engage-
ement and school
connectedness as the way
to improve emotional well-
being and learning
outcomes
Health-promoting schools
System change through
capacity building
(a) School-based adolescent health
team
(b) Student surveys to identify
risk and protective factors in
each school
(c) Identification and
implementation of effective
strategies to project
management
(d) External consultant/critical
friend
(1) Preparing and planning
(2) Policy and institutional
anchoring
(3) Professional development and
learning
a
(4) Leadership and management
(5) Relational and organisational
support context
(7) Partnerships and networking
a
Deschesnes et al., 2003
Keywords: Critical issues,
Comprehensive approaches,
Literature review, School
health promotion
Literature review of
comprehensive school
health promotion
Health-promoting schools
(a) Negotiated planning and
coordination to support the
comprehensive, integrated
nature of the approach
(b) Intersectoral action to actualise
the partnership between
school, family and community
(c) Political and financial support
from policy makers
(d) Evaluative research as a
support to implementation
(1) Preparing and planning
a
(2) Policy and institutional
anchoring
(5) Relational and organisational
support context
(7) Partnerships and networking
(continued)
Table I.
Narrative synthesis
findings – proposed
components for
health-promoting schools
implementation
Theoretical and
empirical base
373
Source Focus of article
Theoretical/conceptual
base
Terminology of components used
in the sources
Proposed common terminology
for implementation components
Felner et al., 2001
Keywords: STEP, HiPlaces,
Prevention, restructuring,
Whole school improvement
Empirical report on two
North-American projects
based on building
principles of prevention and
promotion into whole
school change
Eco-developmental school
improvement theory-based
research model
(a) Structural/organizational
characteristics
(b) Attitudes, norms and beliefs of
staff
(c) Climate/-empowerment/
experiential characteristics
(d) Capacity/skills
(e) Practice/procedural variables
(1) Preparing and planning
a
(3) Professional development and
learning
a
(5) Relational and organisational
support context
Hoyle et al., 2008
Keywords: Health-promoting
schools, Capacity building,
Continuous improvement,
School health, School
improvement
Empirical report of health-
promoting schools in
Colorado school District,
USA
Organisational capacity
building in schools and
districts
(a) Visionary/effective leadership
and management structures
(incl. coordinator)
(b) Extensive internal and
external supports (structured
approaches)
(c) Development and allocation of
adequate resources (fiscal and
human)
(d) Supportive policies and
procedures
(e) Ongoing, embedded
professional development
(1) Preparing and planning
(2) Policy and institutional
anchoring
(3) Professional development
(4) Leadership and management
(5) Relational and organisational
support context
(7) Partnerships and networking
(8) Sustainability
Inchley et al., 2007
Keywords: Health-promoting
schools, Process evaluation,
Implementtation
Evaluation report on
health-promoting schools
projects in Scotland
Processes involved in
developing and
implementing health-
promoting schools
(a) School ownership and
empowerment
(b) Leadership and management
(c) Collaboration
(d) Integration of new into
existing practices
(1) Preparing and planning
(2) Policy and institutional
anchoring
(4) Leadership and management
a
(5) Relational and organisational
support context
(6) Student participation
(7) Partnerships and networking
(8) Sustainability
(continued)
Table I.
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Source Focus of article
Theoretical/conceptual
base
Terminology of components used
in the sources
Proposed common terminology
for implementation components
McBride et al., 1999; McBride,
2000
Keywords: School, health
promotion framework
Empirical report on
development of an
Australian model for
health-promoting schools
implementation
Systems theory of
organisational change
(a) Process (needs assessment,
school community school
management, school health
promotion contributing to
comprehensive school health
promotion)
(b) Critical individuals (gateway
personnel, key decision
makers and key workers)
(c) Supports and strategies
(management factors and
health promotion factors)
(d) Evaluation
(1) Preparation and planning
(3) Professional development and
learning
(4) Leadership and management
(5) Relational and organisational
support context
(7) Partnerships and networking
Samdal et al., 2010
Keywords: Health-promoting
schools, Implementation,
Systematic approach,
Sustainability
Empirical report of
implementation of health-
promoting schools in
Norway
Planning and
implementation model for
health promotion
(a) Goal clarity
(b) No goal conflict
(c) Adequate change
(d) Familiar methodology
(e) Complexity
(f) Motivation and personal
interest
(g) The role of management
(h) Integration of the project in the
school policy
(i) Implementation strategy (top
down/bottom up)
(j) Time and economy
(1) Preparing and planning
(2) Policy and institutional
anchoring
(4) Leadership and management
a
(5) Relational and organisational
support context
(6) Student participation
(7) Partnerships and networking
Note:
a
Only one of the two aspects included in this component was covered by this source
Table I.
Theoretical and
empirical base
375
planning models. This focus enables both the identification of the theoretical constructs
that should be addressed in the intervention to achieve organisational and individual
level change, and also the relevant theory on how to implement actions to achieve the
aim of the intervention most successfully (Weiner et al., 2009). The health-promoting
school approach builds on the belief that by achieving change in the school environment
change can also be achieved at individual level (St. Leger, 2000). Thus focusing on the
school as a setting and making structural changes anchored in policies is recommended
as an efficient approach (Whitelaw et al., 2006). Building on implementation theory, in
this initial phase it is important to identify concrete policies, structures and practices for
the complete implementation approach (Hopkins and Jackson, 2003; Heward et al.,2007).
Such policies, structures and practices are intended to help anchor the health-promoting
school approach in the school organisation. Further, early focus and emphasis on
alignment processes that can stimulate readiness and commitment for change among all
relevant stakeholders are core to a successful implementation process (Sabatier, 1997;
Elias et al., 2003; Stith et al., 2006; Flaspohler et al., 2008; Weiner et al., 2009). Weiner et al.
(2009) relate the readiness concept to Bandura’s notions of goal commitment and
collective efficacy (Bandura, 1998). The underlying principle of building readiness for a
health-promoting school approach is to stimulate shared values and beliefs that such an
initiative is important for students’ development and learning and will also positively
influence the organisational climate of the school. Readiness thus underpins the
motivation of the stakeholders to spend time and energy on agreed actions, making it
more likely that the actions will achieve intended impact as they are implemented with
fidelity. A study of teacher motivation in the Norwegian network of health-promoting
schools has confirmed these mechanisms (Tjomsland et al.,2009a).
Several of the sources highlighted the usefulness of establishing a coordination
team for the implementation of the intervention approach, and when needed, also for
the development of the intervention (McBride et al., 1999; Aldinger et al., 2008; Hoyle
et al., 2008; Samdal et al., 2010). In a health-promoting school approach such a team will
in collaboration with stakeholders and based on local needs, have to identify
topics/areas to address and develop actions to initiate the organisational change
process. Close collaboration between the coordination team and the leadership of the
school has been identified as vital for the change process.
In the following sections other core components important for successful
implementation are presented. As emphasised by the sources highlighting the
importance of planning, these components should all be attended to in the preparation
of the implementation. Further, they may be seen to provide an agenda for the
coordination committee and what they need to emphasise throughout the
implementation process.
Policy and institutional anchoring
Four of the sources considered the inclusion of an initiative or actions in the school
policy document (or other plan document) a key principle of successful implementation
(Bond et al., 2001; Aldinger et al., 2008; Hoyle et al., 2008; Samdal et al., 2010). Inclusion
of concrete actions in the school policy plan is also in general intervention and
implementation models found to be of high importance for successful implementation
(Green and Kreuter, 2005). A written policy ensures that priority will be given from the
leadership in terms of facilitation and resource allocation. In addition the statements in
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the policy document commit all stakeholders to work towards achieving the aims
stated and thereby ensuring that effort is given to the agreed aims (Hopkins and
Jackson, 2003; Heward et al., 2007). A statement in a policy document thus gives a
reinforcement of a decision taken through a consultative process by school leadership
and stakeholders and provides an important combination of top-down and bottom-up
initiatives (Samdal et al., 2010). Several of the other sources also addressed indirectly
the importance of anchoring the initiative by highlighting the impact of establishing
routines (Felner et al., 2001), developing ownership and motivation, and setting aside
resources (McBride et al., 1999; Deschesnes et al., 2003; Aldinger et al., 2008).
Anchoring processes in terms of clarifying goals of the intervention approach and
matching them with the overall goals and visions of the school was highlighted in one
of the sources as important to the implementation process (Samdal et al., 2010). This
anchoring representing stimulus of alignment and commitment has also been
identified as a core implementation focus in planning models for health promotion
(Green and Kreuter, 2005) and seems to build readiness for the intervention (Daft, 1999;
Elias et al., 2003).
Professional development and learning
The majority of the sources advocated the importance of professional development and
learning (Bond et al., 2001; Felner et al., 2001; Aldinger et al., 2008; Hoyle et al., 2008;
Samdal et al., 2010). In any school-based change process the teachers are core change
agents. Partners such as health promotion specialists or advisors in the local community
may provide crucial technical support (Leurs et al., 2005; Boot et al., 2010). In line with
general implementation theory the staff’s competence and understanding of what to
achieve and how to achieve it, have been found to be critical to the success and impact of
the organisational change process (Daft, 1999; Hopkins and Jackson, 2003; Mihalic et al.,
2004; Heward et al., 2007; Durlak and DuPre, 2008). With regard to teaching staff a
distinction needs to be made between on-going teacher professional development and
teacher professional learning. Professional development mostly takes place off the school
premises, its content is decided upon by school authorities (a top down approach) and the
focus is primarily on knowledge and less on change of behaviour and attitudes.
Professional learning, however, happens at the school premises and is based on what the
school needs or wants (a bottom up approach), and focuses on knowledge, attitudes, skills,
aspirations and behaviour (Easton, 2008). Professional learning is part of the teacher’s
everyday life in that they are invited and expected to participate in ongoing discussions
on how to initiate and support school development and change (Fullan, 2008).
Not only teaching staff, but all relevant partners in a health-promoting school
process need to be integrated in a professional development and learning process. A
core element of the professional development in intersectoral approaches is a focus on
understanding each others aims and visions (Deschesnes et al., 2010b) (see also the
component, Partnerships and networking). Therefore shared learning experiences in
the professional development processes may be of particular relevance and value.
Professional development and learning may thus be seen to constitute a core base for
building organisational capacity for change and ensure a whole school approach
(Rowling, 2009). Such capacity has been found to be core for developing necessary
understanding, motivation and skills for the implementation of the health-promoting
school approach as well as generating a general attitude and competence for undertaking
Theoretical and
empirical base
377
organisational change processes (Bond et al., 2001; Hoyle et al., 2008; Samdal et al.,2010).
Openness towards change processes is considered a prerequisite for participation in
change actions. Only when staff know what to do and feel competent in how to do it they
can actually contribute to achieving change (Aldinger et al., 2008).
Leadership and management practices
Several of the sources (McBride et al., 1999; Inchley et al., 2007; Aldinger et al.,2008;
Hoyle et al., 2008; Samdal et al., 2010) highlighted the importance of leadership in order to
achieve successful implementation. Establishing leadership as a key factor for school
change is supported by educational research (Fullan, 2008). Concepts and characteristics
of leadership may, however, vary across countries due to political, economic and
educational policies (Thomas et al., 1998). In many countries whilst leadership is
identified as important, when operationalised, it can have a limited focus on human,
financial and resource management or administrative functions. Consequently it ignores
the processes of leadership. A balance of leadership and management has, however, been
found to be core to achieving organisational development and change (Fullan, 1992;
Donaldson, 2001; Farrell et al., 2001; Neil et al., 2001; Kam et al., 2003). The primary
function of the leadership role is to stimulate readiness and motivation for change as well
as providing role modelling and support for staff in their change agent roles (Bandura,
1998). Such a process needs to balance external requirements and internal capacity. This
complexity of leadership is evident in Fullan’s (2001) description of core mind-action sets
of successful leaders: moral purpose; understanding change processes, relationship
building, knowledge building and coherence making. The development and nurturing of
a professional learning community is found to be a functional vehicle for the leadership
role (Fullan, 2001). As outlined in the component Professional development and learning
a continued focus on school development and change can be stimulated through
discussions with staff and relevant stakeholders on visions for the school, and how all
actions and initiatives the school chooses to implement will help them meet and further
develop their visions and aims.
In its management role the leadership needs to put in place practices and structures
that can facilitate organisational development and change. Such practices and
structures are related to resource allocation for professional development and time
frames for teacher collaboration and exchange (Leithwood et al., 2007).
Relational and organisational support context
Seven of the sources addressed the importance of organisational and
contextual/relational support for implementing health-promoting schools. This is also
identified by implementation theory as a core element, primarily operationalised as
climate and culture (Hargreaves et al., 2001), or organisational capacity (Hopkins and
Jackson, 2003; Flaspohler et al., 2008). It includes development of support structures,
strategies and practices which facilitate smooth and efficient implementation of actions
and activities (Weiner et al., 2009). The climate and culture provides exchange of
experiences, role modelling and relational support (Bandura, 1998). Organisational
structures, include timetabling, physical environment and fiscal resources, and
constitute organisational support (Leithwood et al., 2007). In many ways the
development of a relational and organisational support context brings together all the
other seven suggested components for implementation of health-promoting schools.
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Thus, when implementing each component the health-promoting school coordinating
committee, in close collaboration with the school leadership, needs to identify how the
actions contribute to the development of relational and organisational support context.
The close collaboration with the school leadership is vital, as the leadership is both in
control of the resources and structures (organisational support) and represents an
important capacity to align and stimulate the staff (relational support) (Sabatier, 1997;
Bond et al., 2001; Elias et al.,2003).
Student participation
A core element of the health-promoting school is student participation (Parsons et al.,
1996; Jensen and Simovska, 2005). This aspect meets a basic principle of health
promotion, namely involvement of the target group. However, only Inchley et al. (2007)
identified it as an implementation component, although it also was addressed as an
important aspect of the implementation approach by Aldinger et al. (2008) and Samdal
et al. (2010). Student participation has been included as an implementation component
because it constitutes an important element of WHO guidelines for health-promoting
school (Barnekow et al., 2006; Buijs, 2009) from the inception of the initiative. Student
participation may, in line with relational pedagogy, be seen as a means and a goal to
maximise motivation for health and learning (Boyd et al., 2006). That is, students who
experience that their contributions are sought and valued may, according to
self-determination theory, increase their intrinsic motivation and thereby their
academic achievement and well-being (Ryan and Deci, 2000; Danielsen et al., 2009).
Within self-determination theory, intrinsic motivation is important for perceptions of
well-being and is developed by the fulfilment of the three basic needs of autonomy,
relatedness and competence. Teachers provision of cognitive autonomy support by
facilitating students’ participation in decisions where students are being heard and also
have the skills to listen to others’ arguments, is found to empower students to achieve
learning goals and develop self-reliance in their thinking (Stefanou et al., 2004). Doing
something that has a bigger purpose and that students can “believe in” gives them
meaning; and working with others and being part of something bigger further
enhances their relatedness to teachers and fellow students and thereby also their
connectedness to school (Wierenga, 2002). Finally, student participation may also be
seen to develop skills important for current and future civic engagement in work and
society in general ( Jensen and Simovska, 2005) and thereby constitute an important
part of nurturing healthy working lives and strong democracies.
Partnerships and networking
Half of the sources identified the importance of and also the challenges for schools in
establishing partnerships and networking as part of their approaches to develop a
health-promoting school (Deschesnes et al., 2003; Inchley et al., 2007; Aldinger et al.,2008;
Samdal et al., 2010). Frequently, schools look upon partners from a limited and school
focused point of view, either as funding sources or someone who could help the schools
to meet their aims. However, mutually supportive partnerships and networking are
found to be critical for the successful health-promoting school development. This is
established from both empirically based evidence where schools have reported to
experience benefit from mutual partnerships (Leurs et al., 2005; Inchley et al., 2007; Boot
et al., 2010; Tjomsland et al., 2010; Viig et al., 2010), and from theoretical principles of how
Theoretical and
empirical base
379
reciprocal partnerships can contribute to development and change (Deschesnes et al.,
2003; 2010b). Educational research also underscores that it is reasonable to assume that
intersectoral collaboration between health and education ensures efficient use of
resources and competence (Allensworth et al., 1995). This is likely to occur through
mutual exchange and use of cross-disciplinary competence (Bandura, 1998). For example
the health sector is knowledgeable about the principles of health promotion and the
teaching staff are competent on how to bring about change in school and how health
promotion can be related to the aims of school. In order for a partnership to be functional,
a partner focus is needed. That is, emphasis must be given to shared vision and decision
making (Deschesnes et al., 2003; 2010a, b). In this way a mutual learning process can be
established between partners where the partners share experiences as well as tasks and
responsibilities between them. Another important element of a functional partnership is
a mutual commitment towards common goals which means that priority towards
achieving them is more likely to be given.
With the increasing focus on the school as a setting, requiring a whole school approach
of organisational and systemic change (Deschesnes et al., 2003) and giving emphasis to
the involvement of the stakeholders in the school (students, teachers, parents and local
community), changes in roles for health professionals working with schools may also be
required. The health sector is frequently an instigator of health promotion in a school,
requesting that a health approach is integrated into a school’s daily practices. For a
functional partnership it is of particular relevance that the health sector understands the
core mission of schools, and how health promotion can be part of these. This is not to say
that the partnerships are to be unequal, but rather that previous studies (Deschesnes et al.,
2010b) have shown that when the partnering sectors do not have a similar understanding
of the setting, the school, where the implementation takes place, the processes are less
beneficial both to the health promotion process and the school development in general.
Sustainability
Only two of the sources specifically addressed sustainability as an identified component
of implementation of health-promoting schools (Inchley et al., 2007; Aldinger et al.,2008).
However, general implementation theory emphasises the importance of addressing
sustainability. The school leadership is identified as crucial in ensuring sustainability for
the health-promoting school initiatives (Fullan, 1992; Daft, 1999; Fullan, 2001; Larsen and
Samdal, 2008). Fullan (2005, p. ix) defines sustainability in schools as “the capacity of a
system to engage in the complexities of continuous improvement consistent with deep
values of human purpose”. Actions to facilitate sustainability include monitoring
performance of agreed actions and evaluating progress as monitoring and evaluation are
considered core elements in keeping focus and priority on the health-promoting school
initiative over time (Daft, 1999). Moreover, continued focus on institutionalisation
through inclusion in policy documents, professional development and learning for
current and new staff as well as resource allocation have been identified as contributing
to long term programme sustainability (Hoelscher et al., 2004). A critical point in
achieving sustainability, will be to address it when working on each of the other seven
implementation components. In this way a focus aiming at continuity can be ensured.
In Table II a summary of the aim and purpose of each component is listed. Futher,
the theoretical base for the component is listed building on the presentation of the
components above.
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Implementation component Aim of component Theoretical base for component
Examples of literature for
theoretical and empirical
base
Preparing and planning for
school development
Systematic planning identifying clear aims
and priorities, taking into account the
current situation and competence at school
level, and consulting stakeholders, is vital to
achieve sustainable change.
Goal commitment and collective efficacy
Organisational change, school change and
innovation
Bandura, 1998
Hopkins and Jackson, 2003
Heward et al., 2007
Policy and institutional
anchoring
Inclusion of an intervention in policy
documents and use of process to ensure
institutional anchoring is likely to stimulate
commitment in staff and help prioritise
resources to the intervention. The anchoring
processes using strategies of alignment are
core to building readiness and
organisational capacity
Organisational change, school change and
innovation
Implementation theory
Hopkins and Jackson, 2003
Heward et al., 2007
Elias et al., 2003
Professional development
and learning
Training in leadership and identified
priority areas helps build motivation and
competence for executive staff, the core team
and other staff, essential for quality
implementation of change
Organisational change, educational change,
adult learning principles (experiential)
Mihalic et al., 2004
Hopkins and Jackson, 2003
Heward et al., 2007
Easton, 2008 Fullan, 2008
Leadership and management
practices
Leadership actions in building ownership in
the school community and anchoring the
activities to school visions through
feedback, encouragement and expectations
to implement actions are fundamental to
maintain focus and motivation among
stakeholders for agreed change
Social learning theory, social cognitive
theory, social support
Leadership theory
Bandura, 1998
Farrell et al., 2001
Fullan, 2001, 2005, 2008
Kam et al., 2003
Leithwood et al., 2007
(continued)
Table II.
Theoretically based
rationale for the
implementation
components for
health-promoting schools
Theoretical and
empirical base
381
Implementation component Aim of component Theoretical base for component
Examples of literature for
theoretical and empirical
base
Relational and organisational
context
The social relations and the structural
conditions of a school can maximise the
achievement of agreed actions by providing
a stimulating climate and opportunities
Social learning theory, social climate
Organisational capacity
Bandura, 1998
McBride et al., 1999
Sabatier, 1997 Elias, 2003
Hopkins and Jackson, 2003
Flaspohler et al., 2008
Student participation Student participation is a means and a goal
to maximise motivation for health and
learning. It values and provides conditions
for them to be empowered
Self-determination theory, agency, initiative,
school connectedness
Civic engagement
Relational pedagogy
Ryan and Deci, 2000
Jensen and Simovska, 2005
Boyd et al., 2006
Partnerships and networking Active parental involvement in a variety of
ways can facilitate parental support for
values and actions of the school. Involving
relevant collaborators may stimulate action
and commitment through complementary
expertise and expectations
Social learning theory
Social climate
Organisational capacity, including
competence input from partners
Bandura, 1998
Deschesnes et al., 2003
Inchley et al., 2007
Hopkins and Jackson, 2003
Leurs et al., 2005
Boot et al., 2010
Sustainability Long-term maintenance of the initiative is
dependent on a continued focus on
conditions that facilitate and ensure
implementation of agreed actions for change
Implementation theory (institutionalisation
and monitoring)
Hoelscher et al., 2004
Fullan 2005, 2008
Inchley et al., 2007
Aldinger et al., 2008
Larsen and Samdal, 2008
Table II.
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Discussion
The eight implementation components for health-promoting schools identified in this
paper may be seen to fall into and be categorised by Daft’s (1999) three strategies for
implementing activities and change processes in school. His first strategy focuses on
providing direction in line with overall school aims and visions by identifying how the
values of the innovation fit with the overall values and aims of the school. This has
been classified as a prerequisite or confounder of implementation success (Weiner et al.,
2009). The components of Preparing and planning and Policy anchoring may be seen to
contribute to such direction. Daft’s second strategy addresses alignment of teacher and
school efforts to achieve commitment towards an intervention. This strategy matches
the concept of readiness; i.e. to prepare an organisation and the participants for their
participation in implementation action (Elias et al., 2003; Weiner et al., 2009). Such
readiness may be achieved through the two identified components of Leadership and
management, and Professional development and learning. Finally, Daft’s third
strategy aims at identifying structures and practices that will enable the school to
conduct the specific and needed actions. The identified implementation components of
Student involvement, Partnerships and networking as well as Relational and
organisational support structures may thus be seen to fall within this strategy.
Additionally the components of Leadership and management, and Professional
development and learning may nurture a supportive implementation climate and the
specific actions. These results are also in line with other studies that have identified
core elements of successful implementation of health-promoting school practices.
Supportive studies exist for participation and support (Viig and Wold, 2005),
supportive leadership (Weiner et al., 2009; Tjomsland et al., 2009b, 2010), and overall
implementation climate, including relational context addressing collaboration within
school and networking with partners (Leurs et al., 2005; Boot et al., 2010).
The identification of implementation components in this paper represents the first
attempt made in the field to provide a comprehensive theoretical base for
implementation of health-promoting schools. A clear strength of the study is that it
builds on sources reporting on findings from different cultures, representing all
continents except Africa. All the sources included a minimum of five of the extracted
implementation components. The components may therefore be considered globally
applicable regardless of differences in cultures and school systems. The extraction of
components is built on only eight papers as scientific reporting on implementation of
health-promoting school is scarce. This is clearly a limitation of the study and for the
field. With the exception of the literature review by Deschesnes et al. (2003) all the
studies provided systematic descriptions of collection, analyses and interpretations of
the data. Some of them also gave reference to effectivness outcomes of the
implementation factors suggested (McBride et al., 1999; Bond et al., 2001; Felner et al.,
2001; Inchley et al., 2007). Half of the sources (Bond et al., 2001; Felner et al., 2001; Hoyle
et al., 2008; Samdal et al., 2010) provided a broad theoretical framework for their
identification of components. More research is, however, needed to both test the
applicability of the identified implementation components as well as to verify if more
components are warranted.
The identified implementation components for health-promoting schools cover both
individual and organisational needs and capacities. They thereby meet the suggested core
of successful implementation, namely employing a socio-ecological approach to stimulate
Theoretical and
empirical base
383
an interplay between individual and contextual aspects (Greenhalgh et al., 2004;
Wandersman, 2009; Deschesnes et al., 2010a). This socio-ecological interplay represents
an organisational change and learning process. Change in organisational structures and
processes are employed to achieve change in individual level behaviour and perceptions
(Silins et al., 2002; Wang and Ahmed, 2003). This interaction also parallels the overall
aims of the health-promoting school initiative, namely to build supportive contexts to
promote individual level health behaviours and perceptions (St. Leger, 2000). A
prerequisite for the individual change is, however, involvement of the individuals in the
organisational change processes. Involvement of students, staff and collaborators is
therefore vital to the success of the process. Furthermore, involving the target group in the
implementation of actions is considered a key principle of health promotion and also
specifically meets the basic aims of health-promoting schools (Kickbusch, 2003).
Although the components are presented as separate elements they are
interdependent and may be seen to operate in a parallel process. The
interdependency further underlines the socio-ecological dynamic of the
implementation components. They can also be seen to take into account that schools
are complex systems (Shiell et al., 2008; Keshavarz et al., 2010), which frequently have
parallel rather than linear needs and processes. The core individuals in the school to
initiate and facilitate a health-promoting organisational development process are the
principals and their leadership teams. Leadership and management are considered
crucial to stimulate the participants (students, staff and collaborators) to carry out the
needed actions (Illback and Zins, 1995; Diebold et al., 2000; Farrell et al., 2001; Kam
et al., 2003; Larsen and Samdal, 2008; Tjomsland et al., 2010).
Whilst Daft (1999) has identified fairly broad categories of implementation approaches
for health-promoting schools, this paper has presented theory-driven implementation
components that provide greater specificity. This enables practitioners to implement the
health-promoting school initiative with rigour and fidelity. The use of principles from
organizational change theory to explain the mechanisms of each component and thereby
also the interplay between individuals and organization, is unique. No previous study has
systematically aimed at explaining the mechanisms of good implementation practice in
the field of health promotion. The theoretical rational for each component provides a good
base for implementation as it is both clear what processes need to be initiated and why
they are needed. The components identified are relevant for all types of health-promoting
school initiatives regardless of the topic and how it is introduced, i.e. as an initiative taken
locally or as a national requirement. Thus the implementation components can be used to
implement action either that involving the total process of initiating and deciding aim and
content being taken by the school, or the topic or a programme is given to the schools by
local or national authorities. In both these situations emphasis needs to be given to
stimulate interplay between individual and organizational capacities to achieve successful
implementation (Deschesnes et al., 2010b).
Conclusion and implications
Currently the operationalisation of how to implement actions to achieve
health-promoting school has been left to the practitioners, whose practice-based
knowledge varies. This may result in great disparity in implementation delivery and
therefore difference in programme outcomes. Moreover, it may continually
compromise the efficacy outcomes of whole school change for health and learning.
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Through a literature review this paper has identified globally relevant and specific
implementation components for the health-promoting school initiative, thereby
identifying what type of actions are needed from practitioners. By employing
principles from organizational change theory the paper has also provided a needed
theory-driven description of the mechanism for each component, i.e. the rational why
each component is needed. With this information practitioners can better understand
and evaluate if they are performing implementation actions in accordance with
recommended strategies. Furthermore, systematic use of the implementation
components for health-promoting school will also provide a base for reaching the
aims of the health-promoting schools, namely to promote children and adolescents’
health and wellbeing through a supportive school context. From a societal point of
view this is important from the perspective of improved health, wellbeing and learning,
including development of initiative and competence in working in teams to achieve
change and development. Both the health resources and the specific skills acquired
through the health-promoting school approach may also be beneficial for future
functioning in work life and general life as a citizen and social human being. Still
concrete actions on how to operationalise the components are warranted. A separate
complementary paper sets out to describe a theoretical base and concrete guidelines for
what to do when applying the implementation components, i.e. how to operationalise
the implementation components into concrete actions (Filling the black box of
implementation for health-promoting schools, this issue).
Quite few studies were available for the current identification of implementation
components. The included studies are, however, considered to meet scientific
standards for data collection and interpretation, and thereby providing a scientific
basis for the suggested components. More studies are, however, needed on both
implementation processes and their impact on outcomes to supplement the picture
provided by this paper. Specifically, studies are needed that test the suggested
implementation components for health-promoting schools and how they impact
practices and outcomes in terms of change at both organizational and individual level.
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Corresponding author
Oddrun Samdal can be contacted at: Oddrun.samdal@psyhp.uib.no
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... These approaches have largely failed to demonstrate significant reductions in health risk behaviour, and recent years have seen approaches premised on whole school approaches of organisational and systemic change (Macnab, Gagnon, & Stewart, 2014). These approaches might include classroom health education, but are framed within contextual or socio-ecological perspectives that acknowledge the need for the engagement of school stakeholders (such as students, teachers, parents and wider community (Samdal & Rowling, 2011;Storey et al., 2016). The discrete elements of provision and support considered in this study form just a part of the picture. ...
... The WSCC model also emphasises the importance of a supportive psycho-social and educational climate, and a holistic approach that is designed to emphasize the whole to support the development of each child and youth most effectively (Rooney, Videto, & Birch, 2015). The importance of a whole-school approach is a recurring theme from the wider empirical literature, including evaluation studies (De Bourdeaudhuij et al., 2011;Samdal & Rowling, 2011). Nevertheless, in light of evidence that most schools in Europe are currently a long way from a whole-school approach to the promotion of healthy lifestyles, it is worthwhile to consider not just the content, but also the relative efficacy of discrete elements of provision. ...
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The objective of this study was to develop a Europe-based, authoritative list of the most effective components or elements of learning and health support systems influencing school students’ healthy lifestyles education. It was a part of the broader project, ‘Healthy and Physically Active Schools in Europe’ (HEPAS). The basic approach in this study involved the gathering of the opinions of a group of context experts, and then submitting those opinions to structured rounds of analysis and reorganisation. So, the experts were invited to engage with shared statements of the group’s decision-making to reach a group consensus.
... School is the ideal space for educational activities that promote a healthy lifestyle (Adamowitch, Gugglberger & Dür, 2017; Samdal & Rowling, 2011;Buijs, 2009). Health education programs conducted in schools have positive effects both in the short and in the long term (Brunello, Fort, Schneeweis Winter-Ebmer, 2015). ...
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This article addresses ways in which some strategies from Applied Behavior Analysis (ABA) approach contribute to the understanding and increasing of workplace performance and motivation. In this study, we provide the conceptual background, meta-analyze available studies about behavioral approaches, applied in organizational settings, and we describe various factors that influence motivation, including individual learning histories, motivating operations and keys for delivering positive reinforcement effectively. The paper concludes with a discussion of the implications for the practice of entrepreneurial leadership and for further research, offering practical suggestions for improving motivation and productivity in organizational settings.
... Other barriers stem from the low level of implication of the teachers (Jourdan et al., 2011), their low self-efficacy to influence the students' behavior (Clelland, Cushman & Hawkins, 2013), a difficulty to personally relate to the health promotion program's aims and objectives (Ramos et al., 2013) and not considering school health as a priority (Saito et al., 2015). Similarly, there are factors that facilitate the implementation of health programs in HPS, including: (1) continuing education and training courses, and support, for teachers implementing health programs (Moynihan, Jourdan & Mannix McNamara, 2016;Silva et al., 2019;Ramos et al., 2013;Jourdan et al., 2011); (2) higher engagement and implication of the school community (Silva et al., 2019;Ramos et al., 2013); (3) higher level of sustainability and impact of interventions (Passmore & Donovan, 2014); (4) intersectoral collaboration and liaison with the local community (Heesch et al., 2020;Tooher et al., 2017;Hung et al., 2014); (5) promotion of a culture of change and active participation (Heesch et al., 2020;Hung et al., 2014); (6) dissemination of HPS programs amongst schools, organizations and the general population (Silva et al., 2019); (7) integrative and holistic approaches designed, managed and implemented systematically (Ramos et al., 2013;Heesch et al., 2020;Lee & Cheung, 2017;Samdal & Rowling, 2011). ...
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Background There is insufficient evidence about the impact of health promoting schools on the student’s health and academic performance. The aim of this study was to compare the life skills, lifestyle habits and academic performance of 7 th and 8 th grade students registered in health promoting and non-health promoting schools in the Autonomous Community of Aragon. Methods An observational, descriptive, comparative study of the life skills, lifestyle habits and academic performance of 7 th and 8 th grade students registered in 43 randomly selected health promoting and non-health promoting schools was carried out. We used an adapted tool, which was validated through the expert panel technique, to evaluate the students’ life skills (self-efficacy, social skills and affect balance), lifestyle habits (diet, sleep, physical exercise, use of screen and substance abuse) and academic performance. Results The socioeconomic level of the mothers and fathers of the students who attended non-health promoting schools was significantly higher than that of the parents of the adolescents who attended health promoting schools ( p < 0.001). The students who attended non-health promoting schools had better self-efficacy, led a healthier life generally and achieved better academic results ( p = 0.03). Conclusions As opposed to previous studies, which found a positive association between health promoting schools and life skills, lifestyle habits and academic performance, our findings suggest that the impact of these health programs on the students’ health and academic performance is limited. We recommend that the degree of implementation of health promotion programs in health promoting schools is systematically evaluated, and the health promoting school accreditation process and requirements reviewed, in order to ensure that the health of school children and adolescents is safeguarded and promoted in the short, medium and long term.
... Extra-curricular sport and other PA are made available to all who wish to participate, active transport is used by substantial numbers of children to move from home to school and back again, recess and other types of breaks offer additional opportunities for PA, and lesson plans integrate PA as an experiential approach to teaching. Importantly, they are framed within contextual or socio-ecological perspectives that acknowledge the need for the engagement of all school stakeholders (such as students, teachers, parents and wider community) (Samdal & Rowling, 2011;. The support of parents seems to be particularly important (Rivard, Deslandes & Collet, 2010). ...
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This report presents a series of reviews of the scientific literature to summarise the current evidence of the contributions of different school-based settings on the promotion of health-enhancing physical activity. The objectives of this report are: to review evidence from the last ten years of the contributions of school-based physical activity, physical education, and school sport on the promotion of health-enhancing physical activity; to consider the role of certain transversal factors in supporting the promotion of health-enhancing physical activity; to present a series of practical, evidence-based recommendations in support of the subsequent activities in the HEPAS project. The settings are: Physical activity (including Active Breaks; Active Learning; Active Recess; Active Transport; Active Homework); Physical Education (Curriculum physical education Lessons; Teacher Education / Workforce); and School Sport. The settings are supplemented by a set of ‘transversal categories’, which represent mediating factors for effective realisation of the promotion of health-enhancing physical activity are: Inclusion and Diversity; Continuous Professional Development; Facilities, Equipment and Resources; Community Partnerships; and School Events, Project Weeks, Camps.
... School is the ideal space for educational activities that promote a healthy lifestyle (Adamowitch, Gugglberger & Dür, 2017; Samdal & Rowling, 2011;Buijs, 2009). Health education programs conducted in schools have positive effects both in the short and in the long term (Brunello, Fort, Schneeweis Winter-Ebmer, 2015). ...
Chapter
This article addresses ways in which some strategies from Applied Behavior Analysis (ABA) approach contribute to the understanding and increasing of workplace performance and motivation. In this study, we provide the conceptual background, meta-analyze available studies about behavioral approaches, applied in organizational settings, and we describe various factors that influence motivation, including individual learning histories, motivating operations and keys for delivering positive reinforcement effectively. The paper concludes with a discussion of the implications for the practice of entrepreneurial leadership and for further research, offering practical suggestions for improving motivation and productivity in organizational settings.
... 67 The importance of a whole-school approach is a recurring theme in the literature. 68 Nevertheless, in light of evidence that most European schools are currently a long way from a whole-school approach to healthy lifestyle promotion, it is worth considering the content and the relative efficacy of discrete elements of provision. ...
Article
Full-text available
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... These core values are supported by five pillars: a whole-school approach, school quality, evidence-based, involvement of a network of schools and partnering with the surrounding community(Turunen et al., 2017). The values and pillars align closely with the 5 HPSC indicators.The European Health Promoting Schools includes 8 standards broken down into implementation components(Samdal & Rowling, 2011) similar to the 13 strategies and 69 intervention components which guide HPSCs. The standards correspond to different stages of HPS policies, strategy planning, implementation and evaluation which are further accompanied by indicators specific to each standard (Bada et al., 2019). ...
Thesis
In 1986, the World Health Organization called upon public health advocates to invest in settings to promote health (World Health Organization, 1986). For over 20 years, many settings including hospitals (Johnson & Baum, 2001), schools (Rees et al., 2006), universities (Dooris et al., 2014; Suárez-Reyes & Van den Broucke, 2016), have been researched to understand the organizations’ capacity for change and developed into ‘healthy’ settings. Grounded in the settings-based approach, sports clubs (Kokko et al., 2006), have been undergoing similar research and development to increase health promotion actions in this context. However, literature shows that when the settings-based approach is applied to sports clubs, it is rarely implemented or poorly executed (Geidne et al., 2019).With this in mind, this thesis undertook an iterative approach to educate sports clubs on the benefits of promoting health and provide them with a how-to guide for implementing the health promoting sports club approach based on the club’s needs and goals. The objective is for sports clubs to go beyond promoting just one health behavior to one sports club level. To understand health promotion perceptions of sports club actors (managers, coaches, participants), a multi-level questionnaire was created (study 1) and psychometrically validated (study 2). Study 3 created a theoretical model of health promoting sports clubs (HPSC), which includes 3 sports club levels (macro, meso, micro) with 4 health determinants (economic, environmental, organizational, social) working interdependently within the sport club. In addition, evidence-driven guidelines (Geidne et al., 2019) were formulated into 14 strategies and 55 intervention components to create an intervention planning framework targeting the multiple sports club levels and health determinants. To ensure that a participative approach was applied, a concept mapping study directly asked sports club actors what support they thought was needed to increase health promotion actions in sports clubs (study 4). Using stakeholder-generated statements, 14 new intervention components were formulated. Study 5 augmented the previous HPSC club model by including 7 total levels; 4 internal (macro, meso, micro, individual) and 3 external (Sports federations, Public health actors, Government authorities) levels which can impact sports clubs’ ability to promote health. The newly formulated intervention components were categorized into a revised HPSC framework. Study 6 capitalized on eight exemplar French sports clubs currently involved in promoting health; giving concrete examples of how health promotion interventions are implemented in their sports club. Combined, results from this thesis offer sports clubs reasons to invest in health promotion with an implementation plan.
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This study examines an elementary school which during enrolment in the European Network of Health Promoting Schools, 1993–2003, and the Norwegian Physical Activity and Healthy Meals Project, 2004–2006, selected physical activity (PA) as a prioritized area. Survey data, school documents, and focus group data were collected and analyzed through a sequential exploratory strategy. After a decade, the students in the upper grades participated in more PA weekly than allocated by national plans, and PA promotion was formalized in curriculum outlines. The findings suggest that motivated teachers were the core of PA promotion. Teacher motivation was linked to an interplay between individual teacher characteristics: positive attitudes, innovativeness, internalization of practice, and teacher skills; and organizational characteristics: leadership, teacher climate, and working strategies. The study highlights the advantages of utilizing a mixed‐methods approach to data collection and data analyses. The findings could only be reached by an integrative analysis of data from multiple sources, yielding a more comprehensive and in‐depth understanding of the conditions facilitating sustainability of PA promotion in schools as well as other types of policy initiatives.
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Teachers' participation in health promotion was studied in Norwegian schools involved in the European Network of Health Promoting Schools. The study examined how teachers' motivation was related to participation in health promoting activities. The sample consisted of 104 teachers surveyed in 1994 and 1997. The teachers reported high motivation in terms of their attitudes, expectations and intentions at baseline, a high level of participation as well as positive outcome perceptions. Regression analyses suggested that teachers' intentions at baseline were associated with subsequent participation in health promotion. The findings indicate that teachers are inclined to participate in health promotion if they believe that it will result in positive outcomes. Previous experiences with health promoting activities also seem to enhance teachers' participation.
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The focus of this article is on examining Norwegian teachers' perception of what factors at the school's organisational level have facilitated their participation in a school‐based health promotion project. The study is based on 12 semistructured interviews with teachers from two of the pilot schools participating in the European Network of Health Promoting Schools. The findings indicate that there are a number of conditions at the organisational level facilitating the implementation process and the teachers' participation in the project. These conditions are common goals, good leadership, sufficient and available resources, competence and cooperation inside the school and with the local community. The results from this study also indicate that working with the Health Promoting Schools Project helped the teachers in fulfilling many of the goals of the new Norwegian National Curriculum (L97), and in the longer term, also contributed to the implementation of the new reform.