Skar M, Kirstein E, Kapur A
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
World Diabetes Foundation, Gentofte, Denmark.
Child Care Health Dev. 2015 Nov;41(6):1114-23. doi: 10.1111/cch.12231. Epub 2015 Feb 4.
Non-communicable diseases (NCD) are now the leading cause of death worldwide. As habits and lifestyle are established in childhood and adolescence, targeting school children before they develop unhealthy habits offers a window of opportunity to halt and reverse the emerging NCD epidemic. However, few experiences from school interventions in low- and middle-income countries have been collected. Therefore, the aim of this study was to review experiences of implementing school-based health promotion interventions to identify barriers and recommendations for future interventions.
A qualitative investigation of 17 school-based health promotion interventions in low- and middle-income countries was conducted. Data were collected through questionnaires (15 project leaders) and in-depth interviews with nine project leaders. The data from the questionnaires and interviews was triangulated and analysed using content analysis, where themes and categories emerging from the material were explored.
Three key themes emerged from the data: 1) policy environment and stakeholder engagement, 2) health education sessions, and 3) practical health promotion activities. The themes explored the experiences and lessons learned from 17 school-based health promotion projects in low- and middle-income countries. Stakeholders at different administrative levels were important for the projects; however, stakeholders close to implementation were seen to be more engaged. Most projects conducted traditional health education lectures, which formed the basis of their intervention. Promotion of physical activity and healthy eating through participatory approaches were identified; however, barriers such as lack of areas suitable for physical activity and lack of healthy food alternatives in schools can obstruct the successful implementation of interventions.
This study has documented experiences with school-based health promotion in low- and middle-income countries, and has shown that schools can play an important role in facilitating NCD-related behavioural change in children. The study recommends increased emphasis on a whole-school approach where activities focusing on individual behavioural change are supported by interventions improving the structural environment.
非传染性疾病（NCD）现已成为全球主要死因。由于习惯和生活方式在儿童期和青少年期形成，在学龄儿童养成不健康习惯之前对其进行干预，为遏制和扭转正在出现的非传染性疾病流行提供了一个机会窗口。然而，低收入和中等收入国家学校干预措施的经验收集较少。因此，本研究的目的是回顾实施基于学校的健康促进干预措施的经验，以确定未来干预措施的障碍和建议。
对低收入和中等收入国家的17项基于学校的健康促进干预措施进行了定性调查。通过问卷调查（15名项目负责人）和对9名项目负责人的深入访谈收集数据。对问卷和访谈的数据进行三角测量，并使用内容分析法进行分析，探讨材料中出现的主题和类别。
数据中出现了三个关键主题：1）政策环境和利益相关者参与，2）健康教育课程，3）实际健康促进活动。这些主题探讨了从低收入和中等收入国家的17个基于学校的健康促进项目中吸取的经验和教训。不同行政层面的利益相关者对项目很重要；然而，接近实施层面的利益相关者参与度更高。大多数项目开展了传统的健康教育讲座，这构成了他们干预措施的基础。通过参与式方法促进体育活动和健康饮食已得到确认；然而，诸如缺乏适合体育活动的场地和学校缺乏健康食品选择等障碍可能会阻碍干预措施的成功实施。
本研究记录了低收入和中等收入国家基于学校的健康促进经验，并表明学校在促进儿童与非传染性疾病相关的行为改变方面可以发挥重要作用。该研究建议更加重视全校范围的方法，即通过改善结构环境的干预措施来支持关注个体行为改变的活动。
