Emily Darlington

Implementation of a health promotion programme: a 10 year retrospective study

Purpose Implementing health promotion programmes in schools is key to improving children’s health and well-being but difficulties in achieving expected results are often reported in the research literature. Discrepancies between expected and achieved outcomes can originate from differences in contexts. Understanding how interactions between contexts and programmes generate variable outcomes is therefore critical. This study explores the outputs of a programme implemented in different school contexts. The focus is to (1) pinpoint outputs (2) understand the involvement of combinations of contextual factors (3) and identify recurrences in these combinations. Study design and methodology This retrospective study covers a period from 2006 to 2016. Data collection includes 2 sets of data in 8 high schools in the Rhone-Alpes Region in France: written documents and interviews with school staff. Realist evaluation is used to attempt to pinpoint outputs and relating contextual factors. Findings Results highlight the limited outputs of the programme. Differences between schools appear to originate from existing school policy prior to participation, existence of a project team, identification of the issue as priority, and staff turn-over. Analysis of contextual factors led to considering the implementation process as enabling health capacity building and enhanced the capacity of settings and communities to promote health. Limitations The data provided remains partial as there was high staff turn-over, reluctance to participate due to failure to implement the project, and schools being over burdened with other requests. Value Downloaded by BIBLIOTHEQUE CLERMONT UNIVERSITE At 00:46 13 February 2017 (PT) 2 Previous research suggests that top-down implementation of a standard programme is not an efficient strategy for all schools to engage in the development of suitable health promotion policies. A potential way forward is to base support for the local development of health promotion in schools on a better understanding of the contexts in which implementation occurs.

The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes

BackgroundSince stakeholders’ active engagement is essential for public health strategies to be effective, this review is focused on intervention designs and outcomes of school- and community-based noncommunicable disease (NCD) prevention interventions involving children and young people.MethodsThe review process was based on the principles of scoping reviews. A systematic search was conducted in eight major databases in October 2015. Empirical studies published in English, French, Portuguese, and Spanish were considered. Five selection criteria were applied. Included in the review were (1) empirical studies describing (2) a health intervention focused on diet and/or physical activity, (3) based on children’s and young people’s involvement that included (4) a relationship between school and local community while (5) providing explicit information about the outcomes of the intervention. The search provided 3995 hits, of which 3253 were screened by title and abstract, leading to the full-text screening of 24 papers. Ultimately, 12 papers were included in the review. The included papers were analysed independently by at least two reviewers.ResultsFew relevant papers were identified because interventions are often either based on children’s involvement or are multi-setting, but rarely both. Children were involved through participation in needs assessments, health committees and advocacy. School-community collaboration ranged from shared activities, to joint interventions with common goals and activities. Most often, collaboration was school-initiated. Most papers provided a limited description of the outcomes. Positive effects were identified at the organisational level (policy, action plans, and healthy environments), in adult stakeholders (empowerment, healthy eating) and in children (knowledge, social norms, critical thinking, and health behaviour). Limitations related to the search and analytical methods are discussed.ConclusionThere are very few published studies on the effectiveness of interventions based on children’s involvement in school- and community-based NCD prevention programmes. However, interventions with these characteristics show potential benefits, and the merits of complex multi-setting approaches should be further explored through intervention-based studies assessing their effectiveness and identifying which components contribute to the observed outcomes.

Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

BackgroundImplementing complex and multi-level public health programmes is challenging in school settings. Discrepancies between expected and actual programme outcomes are often reported. Such discrepancies are due to complex interactions between contextual factors. Contextual factors relate to the setting, the community, in which implementation occurs, the stakeholders involved, and the characteristics of the programme itself. This work uses realist evaluation to understand how contextual factors influence the implementation process, to result in variable programme outcomes. This study focuses on identifying contextual factors, pinpointing combinations of contextual factors, and understanding interactions and effects of such factors and combinations on programme outcomes on different levels of the implementation process.MethodsSchools which had participated in a school-based health promotion programme between 2012 and 2015 were included. Two sets of qualitative data were collected: semi-structured interviews with school staff and programme coordinators; and written documents about the actions implemented in a selection of four schools. Quantitative data included 1553 questionnaires targeting pupils aged 8 to 11 in 14 schools to describe the different school contexts.ResultsThe comparison between what was expected from the programme (programme theory) and the outcomes identified in the field data, showed that some of the mechanisms expected to support the implementation of the programme, did not operate as anticipated (e.g. inclusion of training, initiation by decision-maker). Key factors which influenced the implementation process included, amongst other factors, the mode of introduction of the programme, home/school relationship, leadership of the management team, and the level of delegated power. Five types of interactions between contextual factors were put forward: enabling, hindering, neutral, counterbalancing and moderating effects. Recurrent combinations of factors were identified. Implementation was more challenging in vulnerable schools where school climate was poor.ConclusionA single programme cannot be suited or introduced in the same manner in every context. However, key recurrent combinations of contextual factors could contribute to the design of implementation patterns, which could provide guidelines and recommendation for grass-root programme implementation.