The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement

Langford, Rebecca; Bonell, Christopher P; Jones, Hayley E; Pouliou, Theodora; Murphy, Simon M; Waters, Elizabeth; Komro, Kelli A; Gibbs, Lisa F; Magnus, Daniel; Campbell, Rona

doi:10.1002/14651858.cd008958.pub2

Cited by 768School Health and Nursing EducationAdolescent Health and BehaviorsPublic Health Policies and Education

The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement

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Langford, Rebecca, Bonell, Christopher P, Jones, Hayley E, Pouliou, Theodora, Murphy, Simon M, Waters, Elizabeth, Komro, Kelli A, Gibbs, Lisa F +2 more·2014·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd008958.pub2PMC PMC11214127

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Abstract

BACKGROUND: The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES: To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS: We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA: We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS: At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS: We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS: The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.

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Strong evidence indicates that multi-component interventions are effective in the promotion of physical activity in the school setting.
“Strong evidence indicates that multi-component interventions are effective in the promotion of PA (14, 63–69).”
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Using the Fast Track randomized prevention trial to test the early-starter model of the development of serious conduct problems
Bierman, K. L., Coie, J. D., Dodge, K. A., Greenberg, M. T., Lochman, J. E., McMahon, R. J., & Pinderhughes, E. E. (2002) · Development and Psychopathology · doi:10.1017/s0954579402004133 · Cited by 119 · see citing works
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Cardiovascular Risk Factors among Third Grade Children in Four Regions of the United States: The CATCH Study
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Disseminating Incredible Years Series early‐intervention programs: Integrating and sustaining services between school and home
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Long-Term Implementation of the Catch Physical Education Program
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Are Differences in Exposure to a Multicomponent School-Based Intervention Associated With Varying Dietary Outcomes in Adolescents?
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Body Mass Effects of a Physical Activity and Healthy Food Intervention in Middle Schools
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Examination of mid-intervention mediating effects on objectively assessed sedentary time among children in the Transform-Us! cluster-randomized controlled trial
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Schoolwide Effects of a Multicomponent HIV, STD, and Pregnancy Prevention Program for High School Students
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Health promoting schools in England - a way forward in development
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Gimme 5 Fruit and Vegetables for Fun and Health: Process Evaluation
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Effects of Antibullying School Program on Bullying and Health Complaints
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Background, conceptualization and design of a community-wide research program on adolescent alcohol use: Project Northland
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Self-citation
Cardiovascular Risk Factors among Children after a 212-Year Intervention—The CATCH Study
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Risk behaviour in adolescence: the relationship between developmental and health problems
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Dietary habits and nutrient intake of Finnish adolescents
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Using Social‐Emotional and Character Development to Improve Academic Outcomes: A Matched‐Pair, Cluster‐Randomized Controlled Trial in Low‐Income, Urban Schools
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Introduction
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Engagement Matters: Lessons from Assessing Classroom Implementation of Steps to Respect: A Bullying Prevention Program Over a One-year Period
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School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial
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Preventive strategies for mental health
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The World Health Organization's Health Promoting Schools framework: a Cochrane systematic review and meta-analysis
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From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation
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The sustainability of public health interventions in schools: a systematic review
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Academic Achievement and Physical Activity: A Meta-analysis
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Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review
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Taking account of context in population health intervention research: guidance for producers, users and funders of research
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School as ideal setting to promote health and wellbeing among young people
Pulimeno, M., Piscitelli, P., Colazzo, S., Colao, A., & Miani, A. (2020) · Health Promotion Perspectives · doi:10.34172/hpp.2020.50 · Cited by 324 · see citing works
Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial
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How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings
Messing, S., Rütten, A., Abu-Omar, K., Ungerer-Röhrich, U., Goodwin, L., Burlacu, I., & Gediga, G. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00055 · Cited by 259 · see citing works
Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom
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Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial
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Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight
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Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children's BMI and energy balance-related behaviors - a systematic review
Verjans-Janssen, S. R. B., van de Kolk, I., Van Kann, D. H. H., Kremers, S. P. J., & Gerards, S. M. P. L. (2018) · PLOS ONE · doi:10.1371/journal.pone.0204560 · Cited by 179 · see citing works
Implications for public health research of models and theories of disability: a scoping study and evidence synthesis
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Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight
Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009728.pub3 · Cited by 178 · see citing works
Why schools should promote students’ health and wellbeing
Bonell, C., Humphrey, N., Fletcher, A., Moore, L., Anderson, R., & Campbell, R. (2014) · BMJ · doi:10.1136/bmj.g3078 · Cited by 169 · see citing works
Self-citation
Obesity prevention and the Health promoting Schools framework: essential components and barriers to success
Langford, R., Bonell, C., Jones, H., & Campbell, R. (2015) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-015-0167-7 · Cited by 166 · see citing works
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One- and Two-Year Effects of the Healthy Primary School of the Future on Children’s Dietary and Physical Activity Behaviours: A Quasi-Experimental Study
Bartelink, N. H. M., van Assema, P., Kremers, S., Savelberg, H. H. C. M., Oosterhoff, M., Willeboordse, M., van Schayck, O. C. P., Winkens, B., & Jansen, M. W. J. (2019) · Nutrients · doi:10.3390/nu11030689 · Cited by 164 · see citing works
Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people
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Addressing nutritional issues and eating behaviours among university students: a narrative review
Almoraie, N. M., Alothmani, N. M., Alomari, W. D., & Al-Amoudi, A. A. (2024) · Nutrition Research Reviews · doi:10.1017/s0954422424000088 · Cited by 162 · see citing works
Global effect of COVID-19 pandemic on physical activity, sedentary behaviour and sleep among 3- to 5-year-old children: a longitudinal study of 14 countries
Okely, A. D., Kariippanon, K. E., Guan, H., Taylor, E. K., Suesse, T., Cross, P. L., Chong, K. H., Suherman, A., Turab, A., Staiano, A. E., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-10852-3 · Cited by 147 · see citing works
Barriers and Facilitators to Sustaining School-Based Mental Health and Wellbeing Interventions: A Systematic Review
March, A., Stapley, E., Hayes, D., Town, R., & Deighton, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063587 · Cited by 153 · see citing works
Health Promoting Schools—a complex approach and a major means to health improvement
Turunen, H. E., Sormunen, M., Jourdan, D., von Seelen, J., & Buijs, G. (2017) · Health Promotion International · doi:10.1093/heapro/dax001 · Cited by 145 · see citing works
What are effective policies for promoting physical activity? A systematic review of reviews
Gelius, P. C., Messing, S., Goodwin, L., Schow, D., & Abu‐Omar, K. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101095 · Cited by 137 · see citing works
College Student Work Habits are Related to Physical Activity and Fitness
Calestine, J., Bopp, M., Bopp, C. M., & Papalia, Z. (2017) · International journal of exercise science · doi:10.70252/xlom8139 · Cited by 135 · see citing works
Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?
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The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research
Langford, R., Bonell, C., Komro, K., Murphy, S., Magnus, D., Waters, E., Gibbs, L., & Campbell, R. (2017) · Health Education & Behavior · doi:10.1177/1090198116673800 · Cited by 130 · see citing works
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Addressing social determinants of health inequities through settings: a rapid review
Newman, L., Baum, F. E., Javanparast, S., OʼRourke, K., & Carlon, L. (2015) · Health Promotion International · doi:10.1093/heapro/dav054 · Cited by 129 · see citing works
Perceived Social Support and Its Effects on Changes in the Affective and Eudaimonic Well-Being of Chilean University Students
Cobo-Rendon, R. C., López-Angulo, Y., Pérez-Villalobos, M. V., & Mújica, A. D. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.590513 · Cited by 141 · see citing works
Consolidating evidence on the effectiveness of interventions promoting fruit and vegetable consumption: an umbrella review
Wolfenden, L., Barnes, C., Lane, C., McCrabb, S., Brown, H., Gerritsen, S., Barquera, S., Véjar-Rentería, L. S., Munguía, A., & Yoong, S. L. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-01046-y · Cited by 130 · see citing works
Developing and Optimising the Use of Logic Models in Systematic Reviews: Exploring Practice and Good Practice in the Use of Programme Theory in Reviews
Kneale, D., Thomas, J., & Harris, K. (2015) · PLoS ONE · doi:10.1371/journal.pone.0142187 · Cited by 126 · see citing works
Resilience and mental health among juveniles: role of strategies for coping with stress
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Health-promoting lifestyle and quality of life among Chinese nursing students
Mak, Y. W., Kao, A. H. F., Tam, L. W. Y., Tse, V. W. C., Tse, D. T. H., & Leung, D. Y. P. (2018) · Primary Health Care Research & Development · doi:10.1017/s1463423618000208 · Cited by 120 · see citing works
A Systematic Review of the Impact of Multi-Strategy Nutrition Education Programs on Health and Nutrition of Adolescents
Meiklejohn, S., Ryan, L., & Palermo, C. (2016) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2016.07.015 · Cited by 120 · see citing works
Family as a health promotion setting: a scoping review of conceptual models of the health-promoting family
Michaelson, V., Pilato, K. A., & Davison, C. M. (2021) · PLOS ONE · doi:10.1371/journal.pone.0249707 · Cited by 120 · see citing works
The Moderating Role of the School Context on the Effects of the Healthy Primary School of the Future
Bartelink, N. H. M., van Assema, P., Jansen, M. W. J., Savelberg, H. H. C. M., & Kremers, S. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16132432 · Cited by 103 · see citing works
School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews
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RESEARCH ARTICLE Open Access The World Health Organization’s Health Promoting Schools framework: a Cochrane
Review, S., Komro, K. A., Gibbs, L., Magnus, D., & Campbell, R. (2016)
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The World Health Organization’s Health Promoting Schools Framework: A Cochrane Systematic Review and Meta Analysis
Langford, R. M., Bonell, C. P., Jones, H. E., Pouliou, T., Murphy, S., Waters, E., Komro, K. A., Gibbs, L. F., Magnus, D., & Campbell, R. M. (2014) · European Journal of Public Health · doi:10.1093/eurpub/cku163.051 · Cited by 15 · see citing works
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The WHO Health Promoting School framework for improving the health and well-being of students and staff
Langford, R. M., Campbell, R. M., Magnus, D., Bonell, C. P., Murphy, S., Waters, E., Komro, K. A., & Gibbs, L. F. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008958 · Cited by 52 · see citing works
Self-citation
The World Health Organization Health Promoting School framework is important for some child health outcomes
Furley, K. (2017) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.13475 · Cited by 13 · see citing works
The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research
Langford, R., Bonell, C., Komro, K., Murphy, S., Magnus, D., Waters, E., Gibbs, L., & Campbell, R. (2017) · Health Education & Behavior · doi:10.1177/1090198116673800 · Cited by 130 · see citing works
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Authors: Langford, R., Bonell, C. P., Jones, H. E., Pouliou, T., Murphy, S. M., Waters, E., Komro, K. A., Gibbs, L. F., Magnus, D., & Campbell, R.
Affiliations: University of Bristol (GB)
Institute of Education, University of London; Social Science Research Unit; 18 Woburn Square London London UK WC1H 0NR
Cardiff University (GB)
The University of Melbourne (AU)
University of Florida Health (US)
ORCID: Langford, Rebecca
Jones, Hayley E
Pouliou, Theodora
Murphy, Simon M
Komro, Kelli A
Gibbs, Lisa F
Campbell, Rona
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2014-04-16
Volume: 2014
Issue: 4
Pages: CD008958-CD008958
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd008958.pub2
PMC: PMC11214127
OpenAlex: W1907658676
Cited by: 768
References: 465
Citations by year: 2026: 73 · 2025: 73 · 2024: 59 · 2023: 54 · 2022: 81 · 2021: 77 · 2020: 76 · 2019: 58 · 2018: 67 · 2017: 58 · 2016: 33 · 2015: 42 · 2014: 14 · 2012: 1
FWCI: 9.98
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
Bristol Research (University of Bristol) (submittedVersion)
Funders: Wellcome Trust (WT087640MA)
Cancer Research UK
British Heart Foundation
Medical Research Council (MR/K023233/1)
Topics: Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Health Sciences › Health Professions › General Health Professions › Adolescent Health and Behaviors
Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
Keywords: health promoting schools, school health promotion, student well-being, academic performance, physical activity, nutrition, bullying, tobacco use, alcohol consumption, sexual health, violence, mental health, school environment, school ethos, family and community involvement, school-based intervention, children and young people, effectiveness review, risk of bias, heterogeneous effects
MeSH terms: Achievement, Adolescent, Child, Child, Preschool, Health Promotion, Humans, Mental Health, Motor Activity, Obesity, School Health Services, Students, Violence, World Health Organization, Health Behavior, Randomized Controlled Trials as Topic, Substance-Related Disorders, Bullying, Reproductive Health

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