National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Reproductive, Maternal, Newborn, Child and Adolescent Health, Division of Noncommunicable Diseases and Health Through Life-Course, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
PLoS One. 2020 Mar 5;15(3):e0230046. doi: 10.1371/journal.pone.0230046. eCollection 2020.
In the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO.
For this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up.
Despite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments.
Only eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.
在世界卫生组织西太平洋区域（世卫组织西太区），大多数青少年都在中学就读。安全、健康和有益的学校环境对青少年的健康和发展至关重要。然而，在该区域的中低收入国家（LMIC），尚未发现针对青少年的基于学校的干预措施的系统评价。因此，迫切需要确定有效的基于学校的干预措施，并确定在西太区青少年健康中成功实施的促进因素。
为了进行这项系统评价，我们使用了五个电子数据库，检索了 1995 年 1 月至 2019 年 3 月间在西太区的 LMIC 中开展的、以促进青少年健康为目的的基于学校的干预措施。我们检索了针对 10 至 19 岁青少年的 RCT 和非 RCT 研究，研究地点为世卫组织西太区，研究内容为健康和行为、学校环境和学业成绩。我们对研究质量、偏倚风险和治疗效果进行了分析，并对有效的干预措施和实施方法进行了总结，以便在扩大规模时考虑采用。
尽管我们采用了广泛的关键词搜索策略，但仅确定了 8 篇文献（涉及 18774 名参与者）。大多数研究使用知识、态度和行为作为结果测量指标。少数研究还包括学校政策和物理环境的变化作为结果测量指标，而仅有 1 项研究使用 BMI、腰围和生活质量作为结果测量指标。这些研究的主题包括艾滋病、性健康和生殖健康、驱虫、营养、肥胖、烟草使用和自杀。一些干预措施被报道在提高知识、态度和行为方面是成功的，但它们的影响和规模有限。不同研究中采用的干预措施各不相同，有的干预措施针对单一行动领域（例如，培养个人技能），有的干预措施则涉及健康促进中的多个行动领域，例如制定健康政策、营造支持性环境和培养个人技能。没有发现关于其他重要问题的干预研究，如筛查、咨询和营造安全有益的学校环境。
在该区域仅开展了八项基于学校的健康干预措施。本研究发现，基于学校的干预措施在改变知识、态度、行为、健康政策和环境方面是有效的。此外，研究还明确了政策支持、涉及多个利益相关者、纳入现有课程以及学生参与是成功实施的关键因素。
