Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Int J Environ Res Public Health. 2019 Jul 9;16(13):2432. doi: 10.3390/ijerph16132432.
: The current study investigated the moderating role of the school context on the effects of a Dutch health promoting school initiative on children's health and health behaviors. : The study used a mixed-methods design. The school context ( = 4) was assessed by the characteristics of the school population, teacher's health-promoting (HP) practices, implementers' perceived barriers, school's HP elements, and dominating organizational issues. Outcomes included objectively assessed BMI z-scores and physical activity (PA), and parent and child-reported dietary intake. Analyses included linear mixed models (four intervention schools versus four control schools), and qualitative comparisons between intervention schools with similar HP changes. : Effects on outcomes varied considerably across schools (e.g., range in effect size on light PA of 0.01-0.26). Potentially moderating contextual aspects were the child's socioeconomic background and baseline health behaviors; practices and perceived barriers of employees; and organizational issues at a school level. : Similar HP changes lead to different outcomes across schools due to differences in the school context. The adoption of a complex adaptive systems perspective contributes to a better understanding of the variation in effects and it can provide insight on which contextual aspects to focus on or intervene in to optimize the effects of HP initiatives.
本研究旨在探讨学校环境在荷兰促进健康学校倡议对儿童健康和健康行为的影响中的调节作用。本研究采用混合方法设计。学校环境（n=4）通过学校人口特征、教师的健康促进实践、实施者感知的障碍、学校的健康促进要素和主导组织问题来评估。结果包括客观评估的 BMI z 分数和身体活动（PA）以及父母和儿童报告的饮食摄入。分析包括线性混合模型（四个干预学校与四个对照学校）和干预学校之间具有相似健康促进变化的定性比较。结果表明，各学校之间的效果差异很大（例如，轻度 PA 的效应大小范围为 0.01-0.26）。潜在的调节性环境方面包括儿童的社会经济背景和基线健康行为、员工的实践和感知障碍以及学校层面的组织问题。由于学校环境的差异，相似的健康促进变化导致了各学校之间的不同结果。采用复杂适应系统的观点有助于更好地理解效果的变化，并能提供关于关注哪些环境方面或进行干预以优化健康促进计划效果的见解。
