Norwegian Health Promoting Schools

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Norwegian Health Promoting Schools

• Dr. Oddrun Samdal
• Research Centre for Health Promotion,University
  of Bergen, Norway

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Outline

• Aims/strategies
• Planning model
• Evaluation / results
• Dissemination

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The European Network of Health Promoting
Schools Member countries as at September 1999
Albania Austria Belgium/Fl. Belgium/Fr. Bulgaria C
roatia Cyprus Czech Rep. Denmark Estonia Finland F
rance Germany Greece Hungary Iceland Ireland Israe
l Italy Kazakhstan
Latvia Lithuania Luxembourg Malta Moldova Netherla
nds Norway Poland Portugal Romania Russian
Fed. Slovak Rep. Slovenia Spain Sweden Switzerland
TFY Rep. of Macedonia Turkey Ukraine United
Kingdom
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The overarching aim

• The Health Promoting school aims at achieving
  healthy lifestyles for the whole school
  population by developing supportive environments
  conducive to the promotion of health.
• A HPS uses its management structures, its
  internal and external relationships, its teaching
  and learning styles and its methods of
  establishing synergy with its social environment
  to create the means for pupils, teachers and all
  those involved in everyday school life to take
  control over and improve their physical and
  emotional health.

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The Health Promoting School concept

• school health policies
• physical environment
• social environment
• community partnerships
• personal health skills
• integrated health services

(St.Leger, 1998, p. 224)
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(MacGregor Currie, 1998, p. 315)
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The Norwegian Network

• Etablished in 1993 as a collaboration between
  Ministries of Education and Health and the HEMIL
  centre
• All schools in the country were invited to
  participate
• 10 schools from 10 different counties were
  selected spring 1994
• The schools committed themselves to three years
  of intervention

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Aims of Norwegian network

• Collaboration between staff,
  students, parents and local community
• Schools themselves identify needs and develop
  interventions
• Interventions should address individual and
  environmental aspects
• Develop strategy plan for health promotion -
  integrate and structure present activities
• Whole school approach

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Work frame for schools

• Three years of interventions
• Four years of evaluation
• Establish project group consisting of teachers,
  students, school nurse and parents
• Identify school/project co-ordinator
• Supervision from HEMIL

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Time frame

• 10 years (1993-2002)
• 1993-94 planning and base-line survey 1995-97
  interventions at school level
• 1998-99 dissemination through regional network
  model, follow-up surveys and process evaluation
• 2000-02 further evaluation, impact and effect
  evaluation, communication of results and further
  dissemination

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Research Centre for Health Promtotion actions

• School visits (tour 1994)
• Annual seminars
• Training and school visit
• Introduced planning tool
• Regular letters to motivate and structure action
• Monthly telephone calls
• Reduced teaching obligation for school
  co-ordinator

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Planning tool

• Used an adapted version of the PRECEDE
  model, planning tool for health
  promotion action and evaluation
• One year of collaborative planning action
  involving school, school health services and
  local community

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Aims of PRECEDE model

• State clear and measureable objectives
• Identify predisposing, reinforcing and
  enabling factors to achieve change
• Theory based development of action basis for
  evaluation

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The PRECEDE model applied in HEFRES
Phase 2 Epidemiological assessment
Phase 3 Behavioural and environmental
assessment
Phase 1 Social assessment
Phase 4 Educational and ecological assessment
Phase 5 Administrative and policy assessment
Predisposing factors
Health promotion
Behaviour
Health education
Reinforcing factors
Health
Quality of life
Environ- ment
Policy Regulations Organization
Enabling factors
Phase 6 Implementation
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The PRECEDE model applied in HEFRES

Subjective School satisfaction/well-being(skol
etrivsel) (Et godt sted å være, er et godt sted
å lære) Freedom from bullying, increased safety,
Togetherness, companionship, friendship Self
confidence Aesthetics Objective School
achievement/grades Absence Vandalism
Phase 1 Social assessment
Quality of life
Phase 9 Outcome evaluation
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The PRECEDE model applied in HEFRES
Phase 1 Social assessment
Phase 2 Epidemiological assessment
Health indicators Energy (overskudd) Well-being
Concentration Physical fitness Subjective health
complaints Illness
Health
Quality of life
Phase 9 Outcome evaluation

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The PRECEDE model applied in HEFRES
Phase 3 Behavioural and environmental assessment
Phase 1 Social assessment
Phase 2 Epidemiological assessment
Behaviour Lifestyle The holy four Coping/self
efficacy Bullying Utilizing school health
services Environment Economic Physical Social S
ervices
Behaviour
Health
Quality of life
Environment
Phase 8 Impact evaluation
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The PRECEDE model applied in HEFRES
Phase 3 Behavioural and environmental
assessment
Phase 1 Social assessment
Phase 4 Educational and ecological assessment
Phase 2 Epidemiological assessment
Knowledge Attitudes Motivation Values Attitudes
and behaviours of others (teachers, parents
...) Enabling factors Availability of
resources Accessibility Referrals Rules or
laws Skills
Predisposing factors
Behaviour
Reinforcing factors
Health
Quality of life
Environ- ment
Enabling factors
Phase 7 Process evaluation
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The PRECEDE model applied in HEFRES
Phase 2 Epidemiological assessment
Phase 3 Behavioural and environmental
assessment
Phase 1 Social assessment
Phase 4 Educational and ecological assessment
Phase 5 Administrative and policy assessment
Predisposing factors
Health promotion
Behaviour
Health education
Reinforcing factors
Health
Quality of life
Environ- ment
Policy Regulations Organization
Enabling factors
Phase 6 Implementation
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Evaluation

• Aims
• Methods
• Results
• School development

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Aims

• To increase knowledge about
• 1) how aspects of the school environment promote
  or hinder the development of health and
  well-being among students and teachers
• 2) how to intervene on those aspects of the
  school environment

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Evaluation methods

• Qualitative studies
• interviews with teachers, students, school
  project coordinators, school health nurses
• observations at school
• document analysis

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Evaluation methods

• Quantitative studies
• longitudinal surveys among students in grade 5 -
  10 (n1500) twice a year during 1994 - 1998
• control schools from the HBSC study 1993 and
  1997
• longitudinal surveys among teachers (n200)
  annually during 1994 - 1998

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International journal papers

• Haugland, S., Wold, B. Torsheim, T. (in press)
  Relieving the pressure ? The role of physical
  activity in the relationship between school-based
  stress and adolescent health complaints. Research
  Quarterly for Exercise and Sport.
• Hetland, J., Torsheim, T., Aarø, L. E. (2002).
  Subjective health complaints in adolescence
  dimensional structure and variation across gender
  and age. Scandinavian Journal of Public Health,
  30(3), 223-230.
• Hjälmhult E., Wold, B. Samdal, O. (2002)
  Skolehelsetjenesten og helsefremmende arbeid
  Samarbeid mellom helsesøstre og lærere ved de
  norske skolene i Europeisk Nettverk av
  Helsefremmende skoler. Vård i Norden, 1, 42-46.
• Torsheim, T., Aarø, L.E. Wold, B. (in press)
  School-Related Stress, Social Support, and
  DistressProspective Analysis of Reciprocal and
  Multi-Level Relationships. Scandinavian Journal
  of Psychology.

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International journal papers

• Natvig, G. K. (2002) Health and well-being among
  school adolescents. Doctoral dissertation,
  Medical Faculty, University of Bergen.
• Natvig, G.K., Albrekstsen, G., Anderssen, N.
  Quarnstrøm, U. (1999) School-releated stress and
  psychosomatic symptoms among school adolescents.
  Journal of School Health 69 (9), 362-368.
• Natvig, G.K., Albrektsen, G. Quarnstrøm, U.
  (2001) School-related stress experience as a risk
  factor for bullying behavior. Journal of Youth
  and Adolescence 30(5), 561-575.
• Natvig, G.K., Albrektsen, G. Quarnstrøm, U.
  (2001) Psychosomatic symptoms among victims of
  school bullying. Journal of Health Psychology
  6(4), 365-377.
• Viig, N Wold, B. (in press) Facilitating
  Teachers Participation in School-Based Health
  PromotionA Qualitative Study. Scandinavian
  Journal of Educational Change

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Other publications

• 2 magazines distributed to all Norwegian school
• Internal project reports (2x10 school reports)
• Posters and papers at national and international
  conferences
• Teaching
• Web page

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School interventions

• Large variation in what and how much !
• Interdisciplinary curriculum integrating health
  promotion
• Educational programs (Ditt valg/Your choice etc.)
• Health behaviour interventions (nutrition and
  physical activity)

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School interventions, cont.

• Physical environment
• Well-being, anti-bullying
• Cultural events
• Cross-sectorial, integrating school health
  services, police, sports clubs etc.

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School well-being HEFRES schools
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School well-being HEFRES schools
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Impact evaluation Results at selected schools

• Physical aktivity
• Bullying

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School satisfaction (Trivsel) at Lø skole
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Physical activity Haugenstua

• Objective all students shall use their body in
  daily physical activity
• Interventions sports days, tournaments and more
  equipment for activities
• Results A more positive development in physical
  activity than in the control schools

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Lø skole physical active twice a week or more
often
HBSC SURVEYS 1994 og 1997
LØ SKOLE
1994 1996 1997
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Bjerkaker skole Anti-bullying

• Objective No bullying at school.
• Interventions Preventive actions, The Olweus
  program
• Results The number of students reporting to
  being bullied is halfed, and the school is below
  the national mean (of control schools)

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School health servicesHjälmhult E., Wold, B.
Samdal, O. (2002) Skolehelsetjenesten og
helsefremmende arbeid Samarbeid mellom
helsesøstre og lærere ved de norske skolene i
Europeisk Nettverk av Helsefremmende skoler.
Vård i Norden, 1, 42-46.

• 4 patterns of development
• 1. Positive school included nurse, nurse was
  available
• 2. Stagnation school wanted to include nurse,
  but nurse not available
• 3. Negative school did not include nurse, nurse
  was available (and positive)
• 4. Nothing school did not include nurse, nurse
  was not available

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Results at school level (organisation)

• Increased student involvement
• student participation in HEFRES project group
• sports steering committee with students
• surveys in classes about student priorities in
  the project
• assembly (allmøte) led by students
• students representing their school
• youth council was established

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• New/improved collaboration
• parents
• PPT, police
• school health services

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• Strategic plan
• includes the school as a whole - allocation of
  time an resources, commitment
• ensures sustainability of interventions
• does not depend on single individuals
• includes both social interventions and
  educational plans

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Evaluating the results

• Organisational development (4 phases)
• Institutional commitment
• Changes in the school visions and policy
• Changes in staff attitudes and practice
• Changes in student perceptions and behaviours
  related to learning, well-being and school
  environment

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Dissemination strategies

• Nurture pilot network
• Establish regional model networks
• Website
• Interactive web based tool www.miljolare.no/trivse
  loghelse
• Write up documentation/evaluation
• Integrate HP in teacher and school nurse education

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Websites

• www.uib.no/psyfa/hemil/hefres
• www.miljolare.no/trivseloghelse/english

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The future of school-based health promotion in
Norway

• National curriculum
• The social environment of school is valued
  important to learning in
• Human growth and development is included in the
  notion of learning
• School acknowledged as students work place
• The value of human capital (health skills)
• Competing priorities
• How is school effectiveness measured?

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Requirements to succeed

• Train teachers and school health nurses in health
  promotion action and team work
• Evaluate health promotion action in
  school to improve practice and demonstrate
  effect
• Include health promotion in
  education of teachers and nurses

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EFFECTIVE HEALTH PROMOTION

• Theory based
• Goal oriented
• Two-way communication
• Multiple strategies
• High intensity
• Long duration
• Relevant to target group and context