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Cited by 10School Health and Nursing EducationPublic Health Policies and EducationEvaluation and Performance Assessment

Evaluating health promotion in complex adaptive school systems: the healthy primary school of the future

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Bartelink·2019
DOI 10.26481/dis.20191030nb
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Abstract

Background Schools can play an important role in promoting children's health behaviours.A Dutch initiative, 'The Healthy Primary School of the Future', aims to integrate health and wellbeing into the school system.We use a contextual action-oriented research approach (CARA) to study the implementation process.Properties of CARA are its focus on contextual differences and the use of monitoring and feedback to support and evaluate the process of change.The aim of this article is to describe the use of the approach. MethodsFour schools (each with 200-300 children, aged 4-12 years) were included; all located in low socioeconomic status areas in the south of the Netherlands.Data collection methods include interviews, observations, questionnaires, and health and behavioural measurements.Research contributions include giving feedback and providing schools with a range of possibilities for additional changes.The contextual data we examine include schools' health promoting elements, practices of teachers and parents, dominating organizational issues, and characteristics of the student population; process data include the presence of potential barriers to changes.Discussion CARA is an adaptive research approach that generates knowledge and experiences on how to deal with health promotion in complex systems.We think this approach can set an example for research efforts in comparable initiatives.How does the process of change in each school evolve and which factors affect this process?The second key question aims to examine the process of change, i.e., the adoption, implementation, and integration of the HP changes, and its interaction with the school context.Since HPSF takes place in a complex system, some aspects are important to take into consideration.First, the process of change in each school may not be characterized by a linear cause-effect relationship.This non-linearity means that small changes can produce large effects at a so-called 'tipping' point [48,70].When this

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  • It is important from the start of development that both program developers and implementers consider how to achieve a balance between fidelity and adaptation, guided by the context.

    “It is therefore important that already from the start of the development process, both program developers and implementers consider how to achieve a balance between fidelity and adaptation, guided by the context in which an HP program is implemented [6, 19, 22].”

    From Balancing Fidelity and Adaptation: Action‐Oriented Research Towards Implementing a Nutrition Education Program Among Adolescents (2025) · cites this paper as [6]

    The Programme theory section (page unavailable) says school context should be understood at the starting point and should shape the development and implementation of health-promotion changes. The Discussion (page unavailable) recognizes implementation fidelity but says the study focuses on adaptation rather than fidelity; it does not recommend that developers and implementers balance the two from the start. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Schools can be seen as complex adaptive systems with a dynamic and complex nature, in which many actors and contextual factors are continuously changing and interacting.

    “Schools can be seen as complex adaptive systems with a dynamic and complex nature, in which many actors and contextual factors are continuously changing and interacting [6, 7, 8].”

    From Balancing Fidelity and Adaptation: Action‐Oriented Research Towards Implementing a Nutrition Education Program Among Adolescents (2025) · cites this paper as [6]

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  87. CARA bij te dragen aan meer inzicht in de specifieke schoolcontext en de interactie tussen deze schoolcontext en HPSF. De onderzoeksbenadering had consequenties voor alle aspecten van het onderzoek en de rol van de onderzoekers zelf. Het toepassen van CARA heeft geleid tot een breed scala aan ervaringen in het evalueren van veranderingen in een complex adaptief systeem. Alles in overweging nemend, kan naar aanleiding van de beschreven studies in dit proefschrift geconcludeerd worden dat 1) HPSF een veelbelovend Nederlands initiatief is om de gezondheid en het gezondheidsgedrag van kinderen in verschillende schoolcontexten te verbeteren, en dat 2) CARA een mogelijke oplossing biedt om verandering in zo'n complex adaptief schoolsysteem te evalueren. Dit proefschrift laat zien dat het omarmen van de complexe en adaptieve aard van scholen kan bijdragen aan een betere integratie en evaluatie van gezondheidsbevordering in scholen. Publications presented in this dissertation
  88. Bartelink N., van Assema P., Jansen M., Savelberg H., Willeboordse M., & Kremers S. The Healthy Primary School of the Future: A contextual action-oriented research approach. Int J Environ Res Public Health. 2018;15(10):2243
  89. Bartelink N, van Assema P., Jansen M., Savelberg H., Moore G., Hawkings J., & Kremers S. Process evaluation of the Healthy Primary School of the Future: The key learning points. BMC Public Health. 2019;19(1):698.
  90. Bartelink, N., van Assema, P., Kremers, S., Savelberg, H., Oosterhoff, M., Willeboordse, M., van Schayck, O., Winkens, B., & Jansen, M. 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. Nutrients. 2019;11(3):689.
  91. Bartelink, N., van Assema, P., Kremers, S., Savelberg, H., Gevers, D., & Jansen, M. Unravelling the effects of the Healthy Primary School of the Future: For whom and where is it effective? Nutrients. 2019; 11(9):2119.
  92. Bartelink, N., van Assema, P., Jansen, M., Savelberg, H., & Kremers, S. The moderating role of the school context on the effects of the Healthy Primary School of the Future. Int J Environ Res Public Health. 2019;16(13):2432.
  93. Bartelink, N., Mulkens, S., Mujakovic, S., & Jansen, M. Long-term effects of the RealFit intervention on self-esteem and food craving. Child Care in Practice. 2018;24(1):65- 75.
  94. Bartelink, N., Jansen, M., Kremers, S., Mulkens, S., & Mujakovic, S. Long-term effects of the RealFit intervention on body composition, aerobic fitness, and behavior. Child Obes. 2014;10(5):383-391.
  95. Oosterhoff, M., Joore, M., Bartelink, N., Winkens, B., van Schayck, O., Bosma, H. Longitudinal analysis of health disparities in childhood. Arch Dis Child. 2019;0:1-8.
  96. Van Kann, D., Kremers, S., Gubbels, J., Bartelink, N., de Vries, S., de Vries, N., & Jansen, M. The association between the physical environment of primary schools and active school transport. Environ Behav. 2015;47(4):418-435.
  97. Vermeiren, A., Willeboordse, M., Oosterhoff, M., Bartelink N., Muris, P., Bosma, H. Socioeconomic multi-domain health inequalities in Dutch primary school children. Eur J Public Health. 2018;28(4):610-6.
  98. Willeboordse, M., Jansen, M., van den Heijkant, S., Simons, A., Winkens, B., de Groot, R., Bartelink, N., van Schayck, O., et al. The Healthy Primary School of the Future: study protocol of a quasi-experimental study. BMC Public Health. 2016;16(1):639. Presentations at (inter)national conferences
  99. Bartelink, N., van Assema, P., Kremers, S., Savelberg, H., Oosterhoff, M., Willeboordse, M., van Schayck, O., Winkens, B., & Jansen, M. (2019). The effects of the Healthy Primary School of the Future on children's BMI z-score and dietary and PA behaviours. Oral presentation on the 5 th European Conference on Health Promoting Schools, Moscow, Russia, 20-22 November, 2019 (Upcoming).
  100. Bartelink, N., van Assema, P., Jansen M., Savelberg, H., Willeboordse, M., & Kremers, S. (2018). The Healthy Primary School of the Future: A contextual action-oriented research approach. Oral presentation on the 10 th IUHPE European Conference and International Forum for Health Promotion Research, Trondheim, Norway, 24-26 September, 2018.
  101. Kremers, S., Bartelink, N., Hermans, R., van Rinsum, C., Prevo, L., & de Vries, N. (2018). Action-oriented research: Theory and practice of user involvement in evaluation research. Workshop on the 10 th IUHPE European Conference and International Forum for Health Promotion Research, Trondheim, Norway, 24-26 September, 2018.
  102. Bartelink, N., van Assema, P., Kremers, S., Savelberg, H., & Jansen, M. (2017). The Healthy Primary School of the Future. Oral presentation on the 16 th Annual Conference of the International Society of Behavioral Nutrition and Physical Activity, Victoria, Canada, 7-12 June, 2017.
  103. Bartelink, N., van Assema, P., Kremers, S., Savelberg, H., & Jansen, M. (2017). The Healthy Primary School of the Future. Oral presentation on the Dutch Conference for Public Health, Amersfoort, The Netherlands, 13 April 2017.
  104. Bartelink, N., van Assema, P., Kremers, S., Savelberg, H., & Jansen, M. (2016). The Healthy Primary School of the Future. Oral presentation on the Dutch Conference for Public Health, Rotterdam, The Netherlands, 6 April 2016. Work visits abroad Moscow, Russia -5 th European Conference on Health Promoting Schools (2019, upcoming). Trondheim, Norway -10 th IUHPE European Conference and International Forum for Health Promotion Research (2018).
  105. Victoria, Canada -16 th Annual Conference of the International Society of Behavioral Nutrition and Physical Activity (2017).

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Authors
Bartelink
Affiliations
Maastricht University (NL)
Corresponding author
Bartelink
Publisher
University of Maastricht
Published
2019-01-01
DOI
10.26481/dis.20191030nb
OpenAlex
W2989274187
Cited by
10
References
0
Citations by year
2025: 2 · 2023: 4 · 2022: 2 · 2020: 2
Type
dissertation
Language
en
Open access
Locations
Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
  • Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
Keywords
health promotion, complex adaptive systems, school health, evaluation, school system

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