Evaluation of a school health promotion program using the holistic WHO approach

BACKGROUND: A school health promotion program guided by the WHO approach is implemented in approximately 40% of public secondary schools in Lower Austria. Program advisors support participating schools in developing a systematic plan for the promotion of health and wellbeing of all students and teachers. This study aimed to evaluate the effectiveness of the program and identify potential areas for program optimization. METHODS: We applied a non-randomized controlled cluster trial with pre- and post-measurements (T0: October 2021 and T1: June 2022). We invited students, teachers and school principals of 30 program schools (PS) and 29 non-program schools (NPS) to fill in an online-questionnaire. We analyzed data of 2706 students, 451 teachers and 47 principals. RESULTS: The study showed that PS had established more favorable structures for school health promotion (HP) than NPS (e.g., established HP-team, financial resources setting objectives). Although PS implemented more HP activities than NPS (8.5 versus 6.3 activities), they merely took place as one-time events. At student level, an advantage for the PS over time was shown with respect to two out of 19 endpoints (subjective health status [b = 0.19, p < 0.001] and uptake of additionally offered physical activity lessons [b = 0.09; p = 0.04]). In two out of 19 endpoints, an advantage was also shown for the NPS (opportunities for physical activity during lessons and breaks [b = 0.06; p = 0.001], opportunities for participation [b = 0.20; p = 0.001]). At teacher level, in five out of 25 endpoints, the teachers of PS reported more favorable results than NPS’ teachers. CONCLUSIONS: A supportive structure for school health promotion may be helpful for implementing more health promoting activities in schools. However, these activities do not seem to be profound enough to have an impact on the students. Teachers would need more support in implementing HP activities. KEY MESSAGES: • Structures for implementing health promoting activities are in place. • However, the implemented activities did only show limited effect on students.