Applying Salutogenesis in Schools

The chapter addresses the health of children and young people in the school setting with a special focus on experiences from Health Promoting Schools (HPS) and selected health promotion projects in schools. On the basis of brief definitions of the salutogenic orientation and the health promoting school model, comparisons will be conducted with regard to key concepts and principles of the two approaches to children’s health. A brief literature overview on the use of salutogenic concepts in relation to schools and health-promoting schools also is presented and discussed.

Effects of health-promoting school strategy on dental plaque control and preventive behaviors in schoolchildren in high-caries, rural areas of Taiwan: a quasi-experimental design

Background We evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan. Methods A quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data. Results Compared with the CG, the IG had a greater reduction in plaque index among second graders (β = − 0.36) and plaque control record scores among second, fourth, and sixth graders (β = − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG. Conclusions The HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.

Health Promotion in One New Zealand Primary School: a Case Study

<p>This research investigated the way in which one low decile New Zealand primary school in the greater Wellington region practised health promotion, as defined by the World Health Organisation when specifying a health-promoting School. The focus was to discern how one purposefully selected school with many potential social, economic and cultural risk factors undertook the challenge of improving student health. The lens used was that of an experienced community nurse / nurse educator who had previous school nursing experience. Objectives were: to explore the concept of the ‘health-promoting school’ in a specific New Zealand context; to develop and use appropriate research methods to assess a single low decile school in relation to World Health Organization health-promoting school components and checkpoints; to work with the school community to identify health issues; and, to record external and internal changes that could impact on school health over a finite time period. Case study, guided by Hartrick, Lindsey and Hills Health Promotion Nursing framework was selected as the most appropriate method to collect both quantitative and qualitative evidence with the aim of providing a clear understanding of the particular case. Previous research validated an intrinsic case study approach for an inquiry that involved both the process of learning about a specific case and the product of that learning. Triangulated evidence from multiple sources accumulated from multiple data collection methods was used to answer the checkpoints of components within the health-promoting school framework developed by the Western Pacific Region of the World Health Organization in 1996. Results confirmed that the school was working appropriately within the scope of their educational practice to provide a health-promoting school environment for the school community. Gaps and issues identified included an element of talking past each other between the cultures of the education organisation and the nominated health service provider respectively that contributed to a lack of appropriate and accessible health service delivery for the school population. Teaching staff considered that they had insufficient access to health knowledge, and input from health service staff did not meet health education requirements for the school. Staff preference for increased school nurse involvement was not realised. The consequence was that two outside agencies (KiwiCan and Life Education Trust) delivered the bulk of the Health and Physical Education curriculum which resulted in a degree of fragmentation of health education for students. The issues that were identified demonstrated that health services in the area were not satisfactorily meeting the needs of the community and were not addressing the health inequities for the predominantly Pacific Island and Maori students and of their families that formed the school community. The conclusion reached was that a full-service school approach should be considered by the school and the local District Health Board as one way to overcome the current lack of access to health services for the school community.Assertions included the potential integration of locally available services by a school-based nurse coordinator supported by health professionals (Nurse Practitioner and Pacific Island Community Health Worker) and social workers. The vision included professionals working within their professional scopes of practice as part of a Primary Health Organisation with the aim of appropriately addressing the health inequities experienced by the school population.</p>

Health Promotion in One New Zealand Primary School: a Case Study

<p>This research investigated the way in which one low decile New Zealand primary school in the greater Wellington region practised health promotion, as defined by the World Health Organisation when specifying a health-promoting School. The focus was to discern how one purposefully selected school with many potential social, economic and cultural risk factors undertook the challenge of improving student health. The lens used was that of an experienced community nurse / nurse educator who had previous school nursing experience. Objectives were: to explore the concept of the ‘health-promoting school’ in a specific New Zealand context; to develop and use appropriate research methods to assess a single low decile school in relation to World Health Organization health-promoting school components and checkpoints; to work with the school community to identify health issues; and, to record external and internal changes that could impact on school health over a finite time period. Case study, guided by Hartrick, Lindsey and Hills Health Promotion Nursing framework was selected as the most appropriate method to collect both quantitative and qualitative evidence with the aim of providing a clear understanding of the particular case. Previous research validated an intrinsic case study approach for an inquiry that involved both the process of learning about a specific case and the product of that learning. Triangulated evidence from multiple sources accumulated from multiple data collection methods was used to answer the checkpoints of components within the health-promoting school framework developed by the Western Pacific Region of the World Health Organization in 1996. Results confirmed that the school was working appropriately within the scope of their educational practice to provide a health-promoting school environment for the school community. Gaps and issues identified included an element of talking past each other between the cultures of the education organisation and the nominated health service provider respectively that contributed to a lack of appropriate and accessible health service delivery for the school population. Teaching staff considered that they had insufficient access to health knowledge, and input from health service staff did not meet health education requirements for the school. Staff preference for increased school nurse involvement was not realised. The consequence was that two outside agencies (KiwiCan and Life Education Trust) delivered the bulk of the Health and Physical Education curriculum which resulted in a degree of fragmentation of health education for students. The issues that were identified demonstrated that health services in the area were not satisfactorily meeting the needs of the community and were not addressing the health inequities for the predominantly Pacific Island and Maori students and of their families that formed the school community. The conclusion reached was that a full-service school approach should be considered by the school and the local District Health Board as one way to overcome the current lack of access to health services for the school community.Assertions included the potential integration of locally available services by a school-based nurse coordinator supported by health professionals (Nurse Practitioner and Pacific Island Community Health Worker) and social workers. The vision included professionals working within their professional scopes of practice as part of a Primary Health Organisation with the aim of appropriately addressing the health inequities experienced by the school population.</p>

Health Promoting Special Schools for Children and Young People With Intellectual Disabilities in Poland: Development of Standards and Self-Evaluation Procedures

The purpose of the study was to present the process and results of developing standards and self-evaluation procedures for health promoting special schools (HPSS) for children with intellectual disabilities. The work was undertaken in order to address the needs of special schools interested in establishing a health promoting school (HPS). We used following methods: 1) Preparation: interviews with principals and teachers at 8 special schools, as well as regional HPS network coordinators, visits to 4 schools; 2) Development of HPSS project standards, self-evaluation procedures and tools: consultations with representatives of 8 schools and with regional coordinators; 3) Pilot study of HPSS the self-evaluation procedure and tools at 8 schools and development of a finalised version: direct observation, document analysis, interviews with selected participants, survey studies of school staff and students’ parents, testing students using one of the following methods: “Draw and write”, “Draw and tell”, conversation or written response. The study included people supporting HPS on a national and regional level, school principals and health promotion coordinators from special schools for students with intellectual disabilities. The pilot study was conducted on a group of 341 teaching staff, 148 non-teaching staff, 468 parents of students, and 435 students. The analysis of the study’s reports and consultations with school principals and health-promotion coordinators from participating schools guided the development of the final version of standards, in addition to the associated model of HPSS and self-evaluation procedure along with a set of tools to measure the accomplishment of the standards. The HPSS standards and self-evaluation procedure were approved by the Ministry of National Education and officially disseminated, with special schools gaining the opportunity to apply for the Health Promoting School National Certificate. The self-evaluation element of HPSS makes it possible to improve the activities of special schools with respect to health promotion while encouraging collaboration and exchange of ideas with regular schools.

A Model for Creating a Common Health Promoting School Environment

Introduction: Deterioration of students’ health, the absence of scientific substantiation of consistent actions, key directions and indicators of work of comprehensive schools in the sphere of health protection of participants in the educational process determine the purpose of the study to give a rationale for the algorithm and model of creating a common health promoting school environment. Materials and methods: The study was carried out in four directions: 1) study of health promoting activities in modern schools; 2) analysis of indicators of socio-psychological climate of schools; 3) study of the lifestyle, work pressure and schedule, health status and psychological well-being of teachers; and 4) study of foreign instruments for assessing health promotion interventions at schools. The objects of the study included comprehensive schools, schoolchildren, teachers, and foreign instruments for assessing health promotion interventions at schools. The research materials were statistically processed by nonparametric methods using Statistica 13.3 software. Results: Most of the surveyed Russian schools are at the initial stages of developing health promoting frameworks. Based on the expert statistical analysis of health promotion interventions of Russian schools at different levels of development and having different achievements in the field of preventive activities, effective directions and specific indicators for assessing results at each stage of creating a common preventive environment in a comprehensive school were identified and substantiated. Conclusions: An algorithm and a model of a common preventive school environment consisting of seven components have been developed and a system for its monitoring by key indicators, the subjects and objects of which are students, their parents and teachers, has been substantiated. The results of health promoting activities at school include health improvement in schoolchildren and teachers, their emotional well-being, a decreased prevalence of behavioral risk factors, and improvement of knowledge and skills in relation to health and of the academic performance of students.

COVID-19 and the Health Promoting School in Italy: Perspectives of educational leaders

Objective: International agencies report the importance of health promotion in planning educational strategies and school management in response to the COVID-19 pandemic. This study aimed to identify the benefits of using a Health Promoting School (HPS) approach to guide educational and school policy during the COVID-19 epidemic in Italy, the main objectives and practices to be implemented, and the challenges likely to be faced. Design: A three-phase qualitative and participatory approach: (1) identification of study objectives and relevant data, (2) data collection through an online form using open-ended questions (14 participants), and (3) online meetings to analyse the findings and reach consensus (17 participants). Setting: Educational leaders from the HPS Network in the Lombardy region in northern Italy participated in the study. Method: Qualitative content analysis was undertaken. Answers were coded into meaningful units and then grouped under higher-order headings. Codes, subcategories, categories and themes were identified. Results: Results suggested high potentiality, significance and sustainability of the HPS model during the pandemic. Objectives and actions relevant to each HPS component were identified. Adaptations to content and methodology, timing, continuity and inequalities requiring specific forms of intervention were identified. Conclusion: This study sought to develop an HPS model relevant to implementation during the COVID-19 epidemic and identified specific lines of action during this challenging period.

Perceptions of participation in school and association with health and wellbeing: comparison among Nigerian and Irish pupils

School participation among pupils is considered a key value of the health promoting school approach. However, few studies have documented the relationship between the school participation of pupils and health and wellbeing outcomes in different geographical contexts, especially looking at developing and developed country contexts. This study investigated the perceptions of Nigerian and Irish pupils on participation in school and reported health and wellbeing. Data was collected using self-completed questionnaires among 333 and 231 primary school pupils in 4th, 5th and 6th classes across 17 schools in Nigeria and Ireland. Logistic regression analysis was used to analyse the data from both countries. There was no statistically significant difference in the mean scores for participation in school activities (NIG mean = 22.8, SD 3.5; IRE mean = 22.3, SD 3.4) and school events (NIG mean = 18.8, SD 3.7; IRE mean = 17.1, SD 3.6). However, participation in school decisions and rules (NIG mean = 17.3, SD 4.7; IRE mean = 15.8, SD 3.6) and health and wellbeing (NIG mean = 16.9, SD 1.7; IRE mean = 15.3, SD 2.4) scores were significantly higher among Nigerian pupils, while positive perception of school participation (NIG mean = 24.2, SD 4.1; IRE mean = 26.2, SD 3.4) was significantly higher among Irish pupils. The findings suggest that Irish and Nigerian pupils have positive perceptions of their schools irrespective of their location and levels of development. However, further research using qualitative approaches might be needed to better clarify dimensions of pupils’ perceptions of school life and school participation among Nigerian pupils in order to substantiate these claims.

Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours

Summary This study sought to understand the current challenges mainstream secondary schools in England face in creating a health promoting school culture for diet and physical activity behaviours. An in-depth qualitative case study of two purposely selected state-funded schools, including interviews with teachers, observations of school activities including meal breaks and a qualitative survey with parents was done. Inductive thematic analysis was used to explore emerging themes. Additional interviews with the leadership team from four further schools were used to develop and refine emerging themes. Four main themes emerged from the data: competing pressures, school environment, personnel and policy. Results demonstrate that schools recognize they have role to play in promoting healthy lifestyle behaviours to pupils; however, several significant barriers were identified such as lack of government support and regulation, school structures and organization, focus on core subjects, business-run canteens and lack of family and community engagement. Given the importance of maintaining a healthy weight throughout the life course, schools have an important role to play in creating healthy environments in which students can easily make a healthy choice. Future school promotion initiatives need to consider addressing the barriers that schools face by working with them and the communities in which they are embedded.