Background: Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization’s Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed. Methods: We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school’s ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. Results: We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/ attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. Conclusion: This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.

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The World Health Organization's Health Promoting Schools framework: a Cochrane systematic review and meta-analysis.

Preventive strategies for mental health

Complex systems approaches to social intervention research are increasingly advocated. However, there have been few attempts to consider how models of intervention science, such as the Medical Research Council (MRC) complex interventions framework, might be re-framed through a complex systems lens. This paper identifies some key areas in which this framework might be reconceptualised, and a number of priority areas where further development is needed if alignment with a systems perspective is to be achieved. We argue that a complex systems perspective broadens the parameters of ‘relevant’ evidence and theory for intervention development, before discussing challenges in defining feasibility in dynamic terms. We argue that whole systems evaluations may be neither attainable, nor necessary; acknowledgment of complexity does not mean that evaluations must be complex, or investigate all facets of complexity. However, a systems lens may add value to evaluation design through guiding identification of key uncertainties, and informing decisions such as timings of follow-up assessments.

https://journals.sagepub.com/doi/pdf/10.1177/1356389018803219

From complex social interventions to interventions in complex social systems: future directions and unresolved questions for intervention development and evaluation

Additional co-authors: Blake Poland, Valery Ridde, Jeannie Shoveller, Sarah Viehbeck,and Daniel Wight

/pdf/taking-account-of-context-in-population-health-intervention-3z6hbekals.pdf

Taking account of context in population health intervention research: guidance for producers, users and funders of research

CONTEXT: The effect of physical activity (PA) on different areas of academic achievement and classroom behaviors and how different characteristics of PA interventions could modify the effect remain unclear. OBJECTIVE: The objective was twofold: (1) to assess the effect of PA interventions on academic achievement and classroom behaviors in childhood and (2) to determine the characteristics of individuals and PA programs that enhance academic performance. DATA SOURCES: We identified studies from the database inception to October 16, 2016. STUDY SELECTION: We selected intervention studies aimed at examining the effect of exercise on academic achievement and classroom behaviors at developmental age. DATA EXTRACTION: Random-effects models were used to calculate pooled effect size for all primary outcomes (language- and mathematics-related skills, reading, composite score, and time in on-task behavior). Positive values represent a direct relationship between PA programs and academic achievement scores or on-task behaviors. RESULTS: A total of 26 studies (10 205 children, aged from 4 to 13) were included. Pooled effect size (95% confidence interval) estimates were as follows: (1) 0.16 (−0.06 to 0.37) for language-related skills; (2) 0.21 (0.09 to 0.33) for mathematics-related skills; (3) 0.13 (0.02 to 0.24) for reading; (4) 0.26 (0.07 to 0.45) for composite scores; and (5) 0.77 (0.22 to 1.32) for time in on-task behaviors. LIMITATIONS: Limitations included the variety of tools used to measure academic achievement and the limited number of studies that reported the effect of after-school PA interventions. CONCLUSIONS: PA, especially physical education, improves classroom behaviors and benefits several aspects of academic achievement, especially mathematics-related skills, reading, and composite scores in youth.

https://pediatrics.aappublications.org/content/pediatrics/early/2017/11/21/peds.2017-1498.full.pdf

Academic Achievement and Physical Activity: A Meta-analysis

The objective of this study was to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement.

Cochrane Developmental

Papers

The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement