16.12.2020

Educational organizations such as universities and secondary and primary schools are irreplaceable environments for providing education but also for promoting health and preventing disease. During the global COVID-19 pandemic, we have evidenced, probably more powerfully than ever before, the value of schools not merely as environments for education, research, development, innovation and social influencing, but also as environments for social and health-related well-being. 

In the global pandemic, universities and schools around Europe have been in the very centre of fast reactions and changes required by the extremely critical situation. Schools have been able to very quickly adopt a central role in promoting to students, in primary and secondary schools, and even to their families about knowledge, attitudes and behaviour related to general hygiene, infection prevention and health-risk reduction. We may speculate that schools have been able to handle their extremely challenging role partly because of their long history in serving as environments not merely for education, research and development, but also for social benefits and health promotion.

 

What is known about the effectiveness of health promotion?

Even though schools have for long, in many European countries since the beginning of the national school systems, been utilized for health promotion (HP) purposes, there remains a severe lack of knowledge about the effectiveness, unintended effects and potentially harmful effects of the school-based health promotion programmes.

Previous research (Jourdan et al., 2016; Langford et al., 2014; Lima-Serrano & Lima-Rodríguez, 2014; WHO, 2017) suggests that schools provide ideal settings for regulations that reduce the risk of non-communicable diseases, promote physical activity, healthy nutrition, prevent smoking and promote mental health and well-being. Even if positive results have been reported, previous research (for example Kong, Liu & Tao, 2016) also reveals a severe lack of knowledge regarding the long-term effects, unintended effects, and side-effects of the interventions. Finally, a strong need to develop a common standard to implement and report on school-based HPI is highly recommended.

 

What are the common features of effective health promotion interventions?

It seems that there are some common features that are typical for effective health promotion interventions. It has been reported that multicomponent interventions, including policy change and multiple stakeholders’ involvement, seem more effective compared to single-component interventions.

It has also been reported that health promotion interventions should address not merely knowledge and attitudes but also consider social influence, behavioural skills and provide training for facilitators. Effective interventions require commitment and active involvement, cooperation and continuity.

 

Looking for further evidence

The COVID-19 pandemic has reminded the world about the essential need for evidence-based knowledge regarding health promotion, infection prevention and health risk prevention. The pandemic has also reminded us about the rapidly changing health promotion requirements and the need for safe and effective interventions, not only for individuals and communities but also for nations, continents and the globe.

The future is uncertain and continually changing, but the value and need for promoting health and preventing disease remain. One may state that the requirements of knowledge and evidence are even growing as the future becomes more complicated and previous models need to be changed.

To add knowledge, we performed a mixed methods literature review to recognise structural elements and common patterns of effective school-based health promotion interventions. The literature review focuses on the broad international perspective, as health promotion interventions need to be effective on the community or national levels, and increasingly also on the global and cross-cultural levels.

We included all reachable empirical studies that were found via several search engines with no restriction on country of origin, participants’ nationality, financial status, gender or health-related topic. The results of the review will be published later.

 

Literature

Jourdan, D., Christensen, J. H., Darlington, E., Bonde, A. H., Bloch, P., Jensen, B. B., & Bentsen, P. (2016). The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes. BMC Public Health, 16, Article e1123.

Kong, K., Liu, J., & Tao, Y. (2016). Limitations of studies on school-based nutrition education interventions for obesity in China: a systematic review and meta-analysis. Asia Pacific Journal of Clinical Nutrition, 25(3), 589–601.

Langford, R., Bonnell, C. P., Johen, H. E., Pouliou, T., Murphy, S. M., Waters, E., Komro, K. A., Gibbs, L. F., Magnus, D., & Campbell, R. (2014). The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. The Cochrane Database of Systematic Reviews, 16(4), Article CD008958.

Lima-Serrano, M., & Lima-Rodríguez, J. S. (2014). Impact of school-based health promotion interventions aimed at different behavioral domains: a systematic review. Gaceta Sanitaria, 28(5), 411–417.

World Health Organization (WHO). (2017). Health Promoting Schools. Copenhagen, Denmark: WHO, Regional Office for Europe.