Health Promoting Schools and Health Promotion in Schools: Two Systematic Reviews

Citation

Weare, K. (2001), "Health Promoting Schools and Health Promotion in Schools: Two Systematic Reviews", Health Education, Vol. 101 No. 5, pp. 243-245. https://doi.org/10.1108/he.2001.101.5.243.2

As the editorial in this edition suggests, there is currently a dearth of good material on the evaluation of the complex, multifactoral HPS approach. This report is therefore a very welcome addition to the sparse literature. It reports on a systematic review of primary studies of the effectiveness of the HPS approach: it also includes a “review of reviews” of other health promoting interventions in schools, looking at work on “topics” such as sex education, exercise, personal hygiene, nutrition, mental health, oral hygiene, safety and substance use.

To be included in this review, studies of HPS had to be either controlled or before‐and‐after. They had to include health promoting activity in three areas, namely the school ethos and/or environment, the curriculum, and the family and/or community. They also had to demonstrate active participation from the school. So the framework used attempted to combine rigour with an ethically sound approach. It will not surprise readers to discover that, of the original 1,067 HPS titles originally identified, only 12 met the inclusion criteria and, of these, only two were considered to be adequately powered randomised controlled trials. However, on the strength of the resultant studies, the report was broadly supportive of the HPS approach, concluding that “the evidence available to support the health promoting school approach was limited but promising”. It concluded that the HPS approach is having a demonstrable impact on the social and physical environment of the school in terms of staff development, school lunch provision, exercise provision and social atmosphere. It found evidence of improvements in health related behaviour, including eating behaviour and exercise and, very cheeringly, that the HPS approach is impacting on aspects of mental, emotional and social health, such as self‐esteem and bullying, which have previously proved difficult to influence. It recommends further investment in, and, of course, further evaluation of, the HPS approach.

The “review of reviews” of health promotion interventions found, again unsurprisingly, that most of the reviews it could include came from the USA. Almost all the interventions demonstrated an improvement in health knowledge, but the impact on attitudes and behaviour was much less reliable. Many interventions were ineffective, and a few positively harmful. Interventions to promote healthy eating, fitness, prevent illness, prevent abuse and promote mental health were more likely to be effective than those which attempted to prevent substance misuse, promote safe sex, and promote oral hygiene. The review again supported the importance of the HPS approach: the interventions which involved not only the curriculum but some aspect of the school environment and/or ethos were more likely to be effective than those which involved the curriculum only, while those that included work with the family were even more likely to be effective.

This report is a useful addition to the growing body of systematic reviews in this area, which use tight, scientific criteria to define their parameters. It is more unusual, and much more valuable than the average review, however, in that it attempts to promote evaluations that reflect both the holistic, multi‐factoral nature of the HPS and also the ethical demands of health promotion, most notably participation, a value that is much neglected in practice in schools and in the health service. Let us hope that those reviews which come afterwards take on the importance of using multi‐method approaches and adhering to key principles.

The next book reviewed here takes this last issue further, and is centrally concerned with the principles on which health promotion should be based.