Obesity prevention and the Health promoting Schools framework: essential components and barriers to success
Open accessAbstract
BACKGROUND: Obesity is an important public health issue. Finding ways to increase physical activity and improve nutrition, particularly in children, is a clear priority. Our Cochrane review of the World Health Organization's Health Promoting Schools (HPS) framework found this approach improved students' physical activity and fitness, and increased fruit and vegetable intake. However, there was considerable heterogeneity in reported impacts. This paper synthesises process evaluation data from these studies to identify factors that might explain this variability. METHODS: We searched 20 health, education and social-science databases, and trials registries and relevant websites in 2011 and 2013. No language or date restrictions were applied. We included cluster randomised controlled trials. Participants were school students aged 4-18 years. Studies were included if they: took an HPS approach (targeting curriculum, environment and family/community); focused on physical activity and/or nutrition; and presented process evaluation data. A framework approach was used to facilitate thematic analysis and synthesis of process data. RESULTS: Twenty-six studies met the inclusion criteria. Most were conducted in America or Europe, with children aged 12 years or younger. Although interventions were acceptable to students and teachers, fidelity varied considerably across trials. Involving families, while an intrinsic element of the HPS approach, was viewed as highly challenging. Several themes emerged regarding which elements of interventions were critical for success: tailoring programmes to individual schools' needs; aligning interventions with schools' core aims; working with teachers to develop programmes; and providing on-going training and support. An emphasis on academic subjects and lack of institutional support were barriers to implementation. CONCLUSIONS: Stronger alliances between health and education appear essential to intervention success. Researchers must work with schools to develop and implement interventions, and to evaluate their impact on both health and educational outcomes as this may be a key determinant of scalability. If family engagement is attempted, better ways to achieve this must be developed and evaluated. Further evaluations of interventions to promote physical activity and nutrition during adolescence are needed. Finally, process evaluations must move beyond simple measures of acceptability/fidelity to include detailed contextual information to illuminate exactly what works, for whom, in what contexts and why.
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Stronger alliances between health and education professionals and the impact of future interventions must address health and educational outcomes to improve scalability.
“Stronger alliances between health and education professionals and the impact of future interventions must address health and educational outcomes to improve scalability [39].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [39]
Research on the "health promoting schools" initiative has recommended that process evaluation must move beyond simple measures of acceptability and fidelity to include detailed contextual information.
“Research on the “health promoting schools” initiative has recommended that process evaluation must move beyond simple measures of acceptability and fidelity to include detailed contextual information [39].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [39]
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- Authors
- Langford, R., Bonell, C., Jones, H., & Campbell, R.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Langford, Rebecca
- Venue
- International Journal of Behavioral Nutrition and Physical Activity
- Published
- 2015-02-13
- Volume
- 12
- Issue
- 1
- Pages
- 15-15
- ISSN
- 1479-5868 (ISSN-L)
- PMC
- PMC4330926
- OpenAlex
- W2019135956
- Cited by
- 166
- References
- 83
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 11 · 2023: 13 · 2022: 14 · 2021: 20 · 2020: 21 · 2019: 20 · 2018: 18 · 2017: 18 · 2016: 8 · 2015: 5
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Wellcome Trust (MR/KO232331/1)
- United Kingdom Clinical Research Collaboration (MR/KO232331/1)
- Llywodraeth Cymru (MR/KO232331/1)
- Cancer Research UK (MR/KO232331/1)
- British Heart Foundation (MR/KO232331/1)
- Medical Research Council (MR/KO232331/1, MR/K023233/1)
- Economic and Social Research Council (MR/KO232331/1)
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (MR/KO232331/1)
- 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, childhood obesity prevention, school-based intervention, physical activity promotion, nutrition promotion, fruit and vegetable intake, intervention fidelity, family involvement, health and education collaboration, process evaluation, implementation barriers, teacher training and support, school environment
- MeSH terms
- Adolescent, Child, Health Promotion, Humans, Outcome and Process Assessment, Health Care, School Health Services, Schools, Students, Health Behavior, Pediatric Obesity
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.
Statistics and arithmetic are recomputed, not judged.
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