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Cited by 92School Health and Nursing EducationAdolescent Health and BehaviorsAdolescent Sexual and Reproductive Health

School-based interventions to promote adolescent health: A systematic review in low- and middle-income countries of WHO Western Pacific Region

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Xu, Tao, Tomokawa, Sachi, Gregorio, Ernesto R., Mannava, Priya, Nagai, Mari, Sobel, Howard·2020·PLOS ONE
DOI 10.1371/journal.pone.0230046PMC PMC7058297
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Abstract

BACKGROUND: In the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO. METHODS: For this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up. RESULTS: Despite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments. CONCLUSIONS: Only eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.

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  • The combination of effective components within the collaborative individual- and system-level approach for adolescents aged 10 to 19 years involved shaping knowledge through educational instructions and experiments, creating associations with stimuli that cue healthy behaviours, and establishing antecedents to facilitate healthy food choices.

    “However, our review found that the combination of effective components within the collaborative individual- and system-level approach for adolescents aged 10 to 19 years involved shaping knowledge through educational instructions and experiments, creating associations with stimuli that cue healthy behaviours, and establishing antecedents to facilitate healthy food choices [17, 19, 53, 54].”

    From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [54]

    The Results (Components of interventions; page unavailable) describe education and training alongside school policies, environmental changes, and cross-sector collaboration. The paper does not identify experiments, stimulus cues, or antecedents facilitating healthy food choices as an effective combination of components. (LLM, conf=0.85)

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  • Socioeconomic and infrastructural differences between HICs and LMICs may influence the effectiveness and feasibility of interventions, and limited access to technology, financial resources, and trained personnel in LMICs may hinder the successful implementation of tech-driven and multi-component interventions that have been promising in HICs.

    “For example, the socioeconomic and infrastructural differences between HICs and LMICs may influence the effectiveness and feasibility of interventions [54–56] or limited access to technology, financial resources, and trained personnel in LMICs may hinder the successful implementation of tech-driven as well as multi-component interventions that have been promising in HICs [29, 43, 54–56].”

    From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [54]

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  • Combining system and individual-level interventions can create supportive environments that underpin and perpetuate changes in individual behaviour.

    “Combining system and individual-level interventions can create supportive environments that underpin and perpetuate changes in individual behaviour [17, 19, 53, 54].”

    From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [54]

    The Results (Study overview and Components of interventions; page unavailable) describe packages combining school policy, environment, curriculum, and skills training. They report improved school environments and say the study authors believed those changes contributed to the sustainability of interventions. The source does not establish that the environments perpetuated changes in individual behaviour; its sustainability statement concerns the interventions. (LLM, conf=0.84)

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Research works printed but not linked: 2

  1. [17]Aplasca MR, Siegel D, Mandel JS, Santana-Arciaga RT, Paul J, Hudes ES, et al Results of a model AIDS prevention program for high school students in the Philippines. AIDS 1995; 9, S7– S13. 8562004
  2. [28]Winnard D, Denny S, Fleming T. Successful school health services for adolescents: best practice review. 2018.Available at: http://www.schoolnurse.org.nz/Attachments/pdf_files/bestpractice/Best_Practice_Best_Practice_SBHC_Review.pdf (accessed March 22, 2019).

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Authors
Xu, T., Tomokawa, S., Gregorio, E. R., Mannava, P., Nagai, M., & Sobel, H.
Affiliations
  • Chinese Center For Disease Control and Prevention (CN)
  • Shinshu University (JP)
  • University of the Ryukyus (JP)
  • World Health Organization Regional Office for the Western Pacific (PH)
  • National Center for Global Health and Medicine (JP)
Corresponding author
  • Xu, Tao
  • Sobel, Howard
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2020-03-05
Volume
15
Issue
3
Pages
e0230046
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0230046
PMC
PMC7058297
OpenAlex
W3010431912
Cited by
92
References
24
Citations by year
2026: 17 · 2025: 13 · 2024: 19 · 2023: 17 · 2022: 9 · 2021: 12 · 2020: 5
FWCI
2.59
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • World Health Organization
  • Japan Society for the Promotion of Science (18K19671)
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 › Adolescent Sexual and Reproductive Health
Keywords
school-based intervention, adolescent health, low- and middle-income countries, WHO Western Pacific Region, health promotion, knowledge, attitudes and behavior, school environment, implementation factors, scale-up, HIV prevention, sexual and reproductive health, anthelmintic treatment, nutrition, obesity, tobacco use, suicide prevention, school health policy
MeSH terms
Adolescent Health, Adolescent, Developing Countries, Health Plan Implementation, Health Promotion, Humans, Health Knowledge, Attitudes, Practice, Pacific Islands, Quality of Life, School Health Services, Schools, World Health Organization, Pediatric Obesity

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