In the development of health promoting schools, a set of indicators has to be developed in every stage of program formulation, implementation and evaluation. The purpose of this section is to present a number of important issues that need to be taken into account in the development of indicators for health promoting schools, drawing on material from a variety of national contexts.
Contextualisation
While different countries may follow the same broad formulation of aims for health promotion, within specific localities the notion of the HPS requires contextualisation to address the specific needs that arise within specific communities (Deschesnes et al., 2003). Two examples from China and Papua New Guinea (see Table 1) illustrate this point very clearly.
Table 1 shows that although the programmes took physical needs as the point of departure, other dimensions of wellness were integrated in the process.
These examples serve to illustrate the dynamic and integrative nature of
‘wellbeing’. In the Chinese example, helminth infection was taken as the entry point to foster health promotion in schools. This did not limit the program to a disease oriented understanding of health promotion, however, as the strategy undertaken involved family members and a key element in the program was that mutual respect was fostered between parents, teachers and children.
A national audit of health promoting schools in Australia has shown that individual school factors are more significant than state and regional factors in shaping the health promoting school opportunities for students (Northfield et al., 1997). The audit also showed that while the physical environment of schools was regarded as important, greater emphasis was placed on the fostering of social relations to promote the psychosocial dimension of wellness.
The most commonly valued programs and structures were those which served to improve relationships between students within schools through
80 The Health Promoting School: International Advances in Theory, Evaluation and Practice
developing friendships and a feeling of belonging or connectedness via peer education, buddy systems, cross age tutoring home groups and mentor schemes. Similarly valued were pastoral structures, which enabled students to develop close relationships with certain teachers over their school years.
(Northfield et al., 1997)
In the Macedonian context, the focus of health promoting schools is on factors that influence behaviour, rather than on behaviour itself. The factors named are – young people’s knowledge, attitudes, beliefs, perceptions, values,
Dimensions of wellness
China
(Long-Shan et al., 2000)
Papua New Guinea (Tetaga, 1993) Physical Focuses on the reducing of
helminth infections.
Contamination was lowered and the physical environment improved by building of latrines.
Health services for school and personnel were established.
Building of new, practical classroom instead of the use of old traditional hut with circular frame and made of bush grass improved ventilation and improved the learning environment.
Psychological, social, spiritual and emotional
The relationship between the school and the community was improved, because families were involved in the projects
A positive Influence on the morale of teachers and children to be in new classroom came about.
There was a communal consent as to the aims of the HPS.
Intellectual An identification and
prioritisation of problems were done.
Health related policies were established.
A comprehension of the aims by the community brought them to a cooperation to accept the new type of building structure and they raised money to build it.
Proper training of staff led to further empowerment and promotion of the HPS principle (one teacher was able to launch a HPS in another region, because of her experience).
The involvement of the whole community in problem identification and the launching of action to address problems which was marked by a cognitive process integrate other dimensions of well-being.
Table 1.Health Promoting School initiatives in China and Papua New Guinea
skills, self-confidence and self-esteem, as well as the physical and psychosocial environment. The aims are to develop the individual’s responsibility toward her/his own health by promoting healthy lifestyles, as well as on developing environmental care and the care for the community (WHO, 1988).
Active learning principles (called the IVAC – information – action – change approach) are recommended by the Macedonians and serve as a valuable method to change behaviour. In Australia too, students favoured active learning and the opportunity to influence what would be covered in health classes. In a number of schools, groups of students were active in promoting special health events and they saw strong links between health classes and the opportunity to become health promoting within the school and its community (Northfield et al., 1997:25)
Training, partnerships and community involvement
It is necessary that resources within the community have to be identified and empowered to meet the needs, which have been identified. The training of all stakeholders, like teachers and family members will make the program sustainable. Teachers are more confident in teaching health content and knowledge than they are helping students to develop health-related skills. This has implications for curriculum design, resource development and teacher professional development (Northfield et al., 1997).
Teachers do not necessarily accept the notion of the health promoting school and they can easily regard implementation as an extra task and an aggravation of their burden. However, the claimed link between health and learning is an important element that helps to market the health promoting school concept.
Ownership by participants is essential if progress in health promoting school initiatives is to be made, and the importance of teacher attitudes should not be under estimated (Northfield et al., 1997).
The specific tasks of schools and of local initiatives will be eased when national and international systems are in place. The Quality Initiative in Scottish Schools for example, sets its goal to foster collaboration and partnership between health inspectors, education authorities and schools. This has resulted in the development of a coherent and shared national approach. The approach is to place schools at the centre of the drive to improve standards and quality and to meet realistic and challenging targets (Scottish Executive, 1999).
Linking diverse stakeholders from a range of sectors including public and private agencies and organizations is increasingly being recognised as a feature
82 The Health Promoting School: International Advances in Theory, Evaluation and Practice
of best practice in contemporary health promotion. Health promoting schools represent a complex array of issues, and bring together the major sectors of health and education and other related support groups.
Community approaches in health promotion aimed at young people have been shown to hold the greatest potential for success in changing health behaviour. The concept of the health promoting school is an all-embracing approach, which utilises all the opportunities that a school presents in enhancing the health and well-being of children and adults in the community of the school. The community approach is congruent with the socio-ecological model of health promotion. The conceptual model draws together a range of disparate elements to do with health and health education in a framework, which can be used as part of a comprehensive and co-ordinated approach to planning, and development (Denman, 1999:217).
Involvement of parents and family members has been reported to be effective in changing behaviour in rural China (Long-Shan et al., 2000). The Macedonian Network of health promoting schools, in following the European model for health promoting schools, accentuates the stimulation of individual and communal problem solving to take responsibility for change, which they set as the objective of education. They identify the democratisation of learners, and by implication the community, as the ultimate objective. In the evaluation process the demand for empowerment still directs the process.
Conclusion
At the outset of this chapter it was stated that the aim was to outline contours for indicator development for Health Promoting Schools (HPS). Throughout the world, the school is seen as a significant setting for delivering key health messages to young people and for directly influencing their health related behaviour. The nature of the school as an educational setting combines health with educational opportunities and it is the synergy of the school as a place of learning and health enhancement, which has to be employed to its optimal capacity. To be viewed as health promoting, a school has to portray certain features, which will be judged by the requirements and the implications of the broader concept of health promotion. Some of these features include:
• The acceptance of a holistic model of human health and the health promoting school paradigm as a framework on local, regional, national and global levels.
• The recognition that health promoting schools can promote the health of its members, wherever it is starting from on the wellness-illness continuum.
• The recognition that specific contextualised local needs will determine the selection of policies, priorities, programmes, content, strategies, methods, procedures, etc. within specific school contexts.
• The use of the contextualised model as a guide to the selection of relevant indicators against which the policies, programmes, curriculum content, structures, outcomes, processes and partnerships, of a school can be monitored and evaluated.
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