The Integration of Health Promotion in Primary School Settings: Challenges and Opportunities

The aim of this dissertation was to gain more insight into children’s health literacy and to evaluate the implementation and effectiveness of various health-promoting activities in complex and diverse primary school settings.
Considering the potential health impact of school-based health-promoting interventions, it is recommended to integrate health promotion within each school context. To achieve this, it is important to move from evaluating school-based health-promoting interventions in relatively small, controlled contexts to testing the interventions’ impact in diverse, real-world settings in which various external influences and challenges can limit interventions’ effectiveness. When aiming to integrate health promotion in schools, gaining an elaborate overview of a school’s context is necessary to align the subject with a school’s specific wishes and needs. Different intervention variations should be welcomed to make the intervention fitting for various school contexts, as long as the focus is still on an intervention’s underlying principles. The effectiveness of these different intervention variations should be evaluated to gain more insight into their impact. Schools should be guided in the process of stimulating commitment and bottom-up involvement and the creation of a health-related vision, and efforts should be made to reduce the various barriers that schools experience with regard to the implementation of health-promoting initiatives (e.g., limited space in the curriculum, high workload, and limited financial resources). Furthermore, school-wide project groups should be identified and trained to decrease schools’ long-term dependence on external support and to facilitate long-term integration of health promotion in the schools’ context.