Optimizing school-based health-promotion programmes; Lessons from a qualitative study of fluoridated milk schemes in the UK

Background and objective: Some districts in the United Kingdom (UK), where the level of child dental caries is high and water fluoridation has not been possible, implement school-based fluoridated milk (FM) schemes. However, process variables, such as consent to drink FM and loss of children as they mature, impede the effectiveness of these schemes. The aim of this study was to investigate the views of lay participants in FM schemes on the barriers and potential solutions to optimizing schemes and understand how this may inform the implementation of other school-based health-promotion programmes. Design and setting: A qualitative study based on semi-structured interviews and focus groups was carried out in schools participating in FM schemes in the north west of England. Findings: Grounded theory analysis on interview data revealed that the overarching potential solution for optimizing schemes was the need for engagement by schools in the scheme. The degree of engagement with the scheme was related to (the interrelated categories of) acceptability and understanding of FM by the school community. Conclusion: The concept of the need for engagement by schools in health-promotion programmes may be useful for sensitizing health planners to the needs of the school community when developing strategies for the implementation of fluoridated-milk schemes and other school-based health-promotion programmes. </jats:sec