An evidence-based approach to an evaluation of a health promoting schools intervention

Abstract

Research Doctorate - Doctor of Philosophy (PhD)It is now widely accepted that schools are ideal settings for health promotion initiatives which target health and health risk behaviour of school-aged children. The current approach to school-based health promotion, known as the Health Promoting Schools (HPS) approach, embraces the principles of the Ottawa Charter and focuses on opportunities for action on: the formal school curriculum; the school environment (or informal curriculum); and links with the home and wider community. Acceptance and endorsement of the approach has come from several leading international and Australian health promotion organisations. Despite the large amount of interest and enthusiasm generated, there remain a number of significant gaps in knowledge and research evidence, particularly that which addresses the efficacy and effectiveness of the HPS approach. The recent drive by influential bodies for evidence-based heath promotion further supports the need for the application of a systematic framework to the development and evaluation of HPS interventions. This thesis, therefore, describes the application of the Staged Approach to health promotion practice and research model to the development and evaluation of a HPS intervention program which aims to reduce three priority health risk behaviours (smoking, unsafe alcohol use and inadequate sun protection) among a cohort sample of Australian adolescents. Chapter One of this thesis provides the background to the development of the HPS approach, identifies the key gaps in knowledge and research evidence, and outlines the stages of the Staged Approach model and its application to the development and evaluation of a HPS intervention. Chapter Two describes an audit of published literature over an 18-year period to provide an overall picture of the quantity of available evidence within each of the stages of health promotion practice. Chapter Three first identifies health issues which are appropriate to target in school-based health promotion, then applies Stages I and II of the Staged Approach by reviewing the available evidence on adequacy of measures and current prevalence, determinants and target groups. The design, methods and development of a measurement tool for a descriptive, baseline study on the prevalence and determinants of three health risk behaviours among young adolescents in the Hunter Region is outlined in Chapter Four, with the findings from this study described in Chapter Five. A critical review of school-based programs and HPS trials implemented to date is described in Chapter Six, as the first step in evaluating the efficacy and acceptability of interventions (Stage Ill of the Staged Approach). The review considers the extent to which the HPS approach has been conducted in trials, as well as issues regarding study design, outcomes and quality of available research. Chapter Seven describes a randomised controlled trial of a HPS intervention program which aimed to reduce the prevalence of three health risk behaviours among young adolescents in the Hunter region. The model of implementation and specific strategies are outlined, as well as the acceptability and degree of implementation as a process evaluation of the program. Chapter Eight reports on the impact/outcome evaluation of the program concerning its effectiveness in reducing the prevalence of three health risk behaviours and their determinants. Finally, Chapter Nine draws conclusions regarding the effectiveness of the HPS approach, provides recommendations for the implementation of future school-based health promotion initiatives and addresses issues of dissemination and wider adoption of HPS programs as indicated by the final stages of the Staged Approach model