The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review
Open accessAbstract
OBJECTIVE: To examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. STUDY DESIGN: A systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. METHODS: Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. RESULTS: Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. CONCLUSIONS: There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.
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Majority of the reviews (n = 14) evaluated multi-component interventions while three reviews evaluated only health education interventions.
“Majority of the reviews (n = 14) evaluated multi-component interventions [30–32, 34–40, 42–45] while three reviews evaluated only health education interventions [29, 33, 41].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
According to the JBI critical appraisal tool, 14 reviews scored high, two reviews scored moderate, and only one review scored low in terms of methodological quality.
“According to the JBI critical appraisal tool, 14 reviews scored high [30–32, 34–41, 43–45], two reviews scored moderate [33, 42], and only one review scored low [29] in terms of methodological quality (Table 2).”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The healthy eating education components in the four inconclusive reviews included lectures, group discussions, games, distribution of materials via CDs, videos, emails, and text messages, blogs by a health coach, workshops for staff and students, and drama.
“The healthy eating education components included lectures [34, 39, 40], group discussions [40, 44], games [39, 44], distribution of materials via compact discs (CDs), videos, emails, and text messages, blogs by a health coach [44], workshops for staff and students [39], and drama [40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The contents of these school environment components involved FV subscriptions, increased availability of healthy food in canteen, FV plantation, incentives to purchase healthy foods, staff training on healthy cooking, healthy eating posters around schools, enhanced lunch sessions with healthy meals, and replacing SSBs with healthy foods.
“The contents involved FV subscriptions [34, 40], increased availability of healthy food in canteen [34, 39], FV plantation [40], incentives to purchase healthy foods [34], staff training on healthy cooking healthy eating poster [39], healthy eating posters around schools [40], enhanced lunch sessions with healthy meals, and replacing SSBs with healthy foods [40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
Four high-quality reviews (including 43 unique studies) reported inconclusive impacts on eating knowledge and behaviour, particularly for healthy eating knowledge, intake of FV, recommended fat, water, processed snacks, protein, fibre, and SSB.
“Four high-quality reviews (including unique 43 studies) reported “inconclusive” impacts on eating knowledge and behaviour, particularly in terms of healthy eating knowledge [44], intake of FV [34, 39, 40, 44], recommended fat [34, 39, 44], water [34, 40], processed snacks [40, 44], protein [40], fibre [44], and SSB [34].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The studies assessed in the four inconclusive reviews employed RCTs (n = 39), non-RCTs (n = 16), cohort (n = 7), pre-post (n = 7), and quasi-experimental (n = 2) designs.
“The studies assessed in these four reviews employed RCTs (n = 39) [34, 39, 40, 44], non-RCTs (n = 16), cohort (n = 7), pre-post (n = 7) [34], and quasi-experimental (n = 2) designs [44].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The interventions in the four inconclusive reviews were informed by TPB, SCT, TTM, ASE model, principles of interactive technology, SLT, health promotion model (Pender's), SEM, DIT, control theory, information-motivation-behavioural skills model, and community-based capacity building approach.
“The interventions were informed by TPB [34, 39, 40, 44], SCT [39, 40, 44], TTM [39, 44], ASE model, principles of interactive technology, SLT, health promotion model (Pender’s) [44], SEM, DIT, control theory, information-motivation-behavioural skills model [39], and community-based capacity building approach [40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The contents of these family involvement components involved healthy eating lessons, incentives to purchase healthy foods, money rewards for purchasing healthy foods, cooking recipes, and healthy feeding to children.
“The contents involved healthy eating lessons [34, 39, 40, 44], incentives to purchase healthy foods [34, 39], money rewards for purchasing healthy foods [40], cooking recipes [39], and healthy feeding to children [40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The contents of these healthy eating education components involved healthy eating lessons, food preparation, and taste testing.
“The contents involved healthy eating lessons [34, 39, 40, 44], food preparation, and taste testing [40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The school environment components in the four inconclusive reviews included canteen modifications, food distributions, reduced price of fruits, social food marketing, staff trainings, loyalty programmes, gardening, postering, and vending machine modifications.
“The school environment components, working at the school system level, included canteen modifications [34, 39], food distributions [34], reduced price of fruits [44], social food marketing, staff trainings [39], loyalty programmes [34, 39], gardening, postering, and vending machine modifications [40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The intervention duration in the four inconclusive reviews ranged from 12 h to three years, and only one review reported follow-up assessments from immediately to three years after the intervention.
“The intervention duration ranged from 12 h to three years [34, 39, 40, 44] and only one review reported follow up assessments occurred ranged from immediately to three years after the intervention [34, 39, 40, 44].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The family involvement components in the four inconclusive reviews included parents' meetings and workshops, distribution of newsletters, CDs, magazines, calendars, engaging parents in school nutrition council groups, and loyalty programmes.
“The family involvement components included parents’ meetings and workshops [34, 39, 40], distribution of newsletters, CDs, magazines, calendars [39, 40, 44], engaging parents in school nutrition council groups [39], and loyalty programmes [39, 40].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The outcomes in the four inconclusive reviews were measured by 24-h recall, FFQ, KAP, and 3-day food record.
“These outcomes were measured by 24-h recall [34, 39, 40, 44], FFQ [34, 40, 44], KAP [39], and 3-day food record [44].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
The feasibility of multi-component interventions that require additional resources has been questioned, consistent with reporting from one review.
“Furthermore, the feasibility of multi-component interventions that require additional resources has been questioned [52, 62], which is consistent with the reporting from one review [39].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [39]
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- Authors
- McHugh, C., Hurst, A., Bethel, A., Lloyd, J., Logan, S., & Wyatt, K.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- McHugh, C.
- Venue
- Public Health
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 182
- Pages
- 116-124
- ISSN
- 0033-3506 (ISSN-L)
- OpenAlex
- W3015131298
- Cited by
- 54
- References
- 34
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 8 · 2023: 9 · 2022: 12 · 2021: 8
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Public Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion, cc-by-nc-nd)
- Figshare (submittedVersion, cc-by-nc-nd)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion, cc-by-nc-nd)
- Funders
- All Saints Educational Trust
- Topics
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- health promoting schools, adolescent physical activity, adolescent diet, healthy eating, school-based intervention, high school students, family and community involvement, school food environment, intervention effectiveness
- MeSH terms
- Diet, Healthy, Adolescent, Child, Diet, Health Promotion, Humans, School Health Services, Schools, Students, World Health Organization, Health Behavior, Exercise, Randomized Controlled Trials as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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