Heinze Clara, Klinker Charlotte Demant, Sidenius Anne, Krølner Rikke Fredenslund
Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev 2730, Denmark.
National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark.
Health Educ Res. 2025 May 31;40(3). doi: 10.1093/her/cyaf022.
Participatory systems approaches are suggested to address the complex drivers of adolescent health but have not been applied or evaluated in a vocational school setting. This study investigated the implementation of a participatory systems approach to health promotion and its potential for driving system-level changes in vocational schools. We used quantitative data to assess implementation fidelity (reach, recruitment, and dose) and outputs in terms of the potential for system-level changes (engagement, knowledge, and leverage points). Qualitative data examined contextual factors (participant responsiveness, and school and municipal contexts) as potential influences on implementation fidelity and outputs. The results showed that school, municipal, and community actors actively participated in systems mapping and in identifying actions targeting leverage points at various system levels. Engaged and knowledgeable community actors were found to be key in generating ideas targeting the deeper layers of the system, enhancing the potential for successful implementation and system-level change. Implementation fidelity and outputs varied across sites due to varying responsiveness and school and municipal contextual factors. In conclusion, participatory systems approaches in vocational schools are feasible, leading to action ideas with promising leverage points for health promotion. However, a flexible approach tailored to specific school and municipal contexts is needed.
有人建议采用参与式系统方法来应对青少年健康的复杂驱动因素，但尚未在职业学校环境中应用或评估。本研究调查了参与式系统方法在健康促进中的实施情况及其在职业学校推动系统层面变革的潜力。我们使用定量数据来评估实施保真度（覆盖范围、招募情况和剂量）以及在系统层面变革潜力方面的产出（参与度、知识和杠杆点）。定性数据考察了背景因素（参与者反应、学校和市政背景）作为对实施保真度和产出的潜在影响。结果表明，学校、市政和社区行为者积极参与系统映射，并确定针对不同系统层面杠杆点的行动。发现积极参与且知识渊博的社区行为者是产生针对系统深层层面想法的关键，增强了成功实施和系统层面变革的潜力。由于反应程度以及学校和市政背景因素的不同，实施保真度和产出在各地点有所差异。总之，职业学校中的参与式系统方法是可行的，能产生具有促进健康的有前景杠杆点的行动想法。然而，需要一种针对特定学校和市政背景量身定制的灵活方法。
