School-based interventions and campaigns are used to promote health and address a wide variety of public health problems. Schools are considered to be key sites for the implementation of health promotion programmes because of their potential to reach the whole population in particular age-groups and instil healthy patterns of behaviour early in life. However, evidence for the effectiveness of school-based health promotion interventions is highly variable.
A team of SPHR researchers from Exeter and Sheffield universities conducted a systematic realist review of the implementation of health promotion in schools. This approach allowed the research team to focus on processes of successful implementation and important school-related contexts, opportunities and constraints related to their feasibility and sustainability (PROSPERO register no. CRD42012002640). The protocol for this research was published in the Systematic Reviews Journal.
The study identified four groups of implementation mechanisms relating to: (i) preparing for implementation/introduction; (ii) initial implementation; and (iii) embedding into routine practice. The fourth group of mechanisms – adaptation and evolution – related to all stages of implementation, including: clarity about ‘core’ (essential) versus ‘peripheral’ (optional/contingent) programme elements. The views of key stakeholders from local schools were sought during the project.
The findings describe the circumstances in which the successful implementation of programmes requires: more pre-delivery consultation, effective pupil engagement, reciprocity with the other goals and roles of teachers and pupils, concordance between programme and school activities and priorities, integration into the life of the school, proper engagement and motivation of those delivering the programmes. Also, insights into the pros and cons of conducting systematic reviews about implementation processes and factors, separately from reviewing evidence of effectiveness, was presented at the Australasian Evaluation Society conference, in Brisbane in September.
The research team are currently working with Public Health England to help package the more compelling and applicable findings for different audiences.