429871

2012

GHP19110.1177/1757975911429871E. SeniorGlobal Health Promotion

Original Article
Becoming a health promoting school: key components of planning
Elizabeth Senior1

Abstract: This article looks at the practicalities of implementing the health promoting school (HPS)
framework, including conducting a whole school audit, to enable a primary school to successfully
adopt the HPS principles. A partnership agreement was signed, between EACH Social and Community
Health which is a local Community Health Centre and a primary school in the Eastern suburbs of
Melbourne, in Australia. An audit was conducted of the school community with four follow up focus
groups of students from grades 3 to 6. Qualitative data was gathered from 20 teachers at the school
at a professional development day facilitated by the health promotion staff of the Community Health
Centre. The results of the school audit identified that students in grades 3 to 6 and parents valued the
outside environment of the school most highly. The staff valued staff attributes most highly.
Suggestions from students to improve the school included improving the canteen and outside
environment. Staff were most concerned about fitness of both the staff and the students. Parents also
identified lack of healthy eating as a concern. The school community sees the value of adopting the
HPS framework, however on-going structured support is required if the school is to successfully
adopt the HPS approach. The school community needs to understand that the move toward cultural
and environmental change is slow. Successful adoption of the HPS model requires time and
collaboration. The emphasis needs to be on supporting teachers to change their school from within.
Relationships are important. (Global Health Promotion, 2012; 19(1): 2331)
Keywords: schools, education settings, health promotion, collaboration, partnership

Introduction
The health promoting school (HPS) is a global
concept relevant to achieving health and education
as expressed in the United Nations goals of Health
for All and Education for All. The HPS approach is
based on the social model of health. It emphasizes
the entire organization of the school (16). The HPS
model is used extensively throughout Europe. The
European Network of Health Promoting Schools
(now Schools for Health in Europe) was formally
established in 1992. This union between the Council
of Europe, the World Health Organisation and the
Commission of the European Communities has
given the HPS model status and embedded it within
the educational curriculum of schools in Europe

(1,4). In Australia by contrast, the term is poorly

understood by teachers (2) and only partially
recognized in school settings (3). This is despite
many health departments or foundations funding
projects and activities that use the HPS framework.
Stewart-Brown (4) and numerous other authors
(69) indicate that the multi-model, whole of school
approach espoused by the HPS framework is most
effective in producing long term changes to students
attitudes. The HPS model works on inter-related
areas within the school environment. This is in
contrast to specific one-dimensional programs (9,10).
The HPS model encompasses six components.
These are: healthy school policies, the schools
physical environment, the schools social
environment, individuals health skills and action

1. EACH Social and Community Health, 46 Warrandyte Rd, Ringwood, 3134, Victoria, Australia. Email: lsenior@each.com.au
(This manuscript was submitted on August 10, 2010. Following blind peer review, it was accepted for publication on April
25, 2011)
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31; 429871 Copyright The Author(s) 2012, Reprints and permissions:
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E. Senior

24

competencies, community links, and health services

(7). There is evidence to suggest that social and
emotional factors are of primary importance when
it comes to factors that affect learning. These
include interactions between students, teachers and
the wider community, as well as the culture of the
school (1113). Many authors also agree that
health outcomes are improved if the health related
issues are addressed by the students teachers
both within the class-room as part of the students
daily lessons, and seamlessly throughout the school
(4,11,14).
Consistency between school policies and how the
school actually functions has also been identified as
an important aspect of the HPS model. Schools that
have policies and practices that make social inclusion
a priority and have a high commitment to educational
outcomes experience reduced risky behaviours in
their students, with the accompanying improvement
in emotional and physical wellbeing (10,15,16).
Schools that have good links between the local
community and the students parents enhance
the activities of the school and avoid the cultural
gap that can occur between home and school
(6,7,10). The schools physical environment is also
important, with WHO finding that the physical
school environment has a strong influence on
childrens health (17).
A considerable body of evidence has been collected
over the last 20 years demonstrating that healthy
students learn better. School programs that are
holistic, integrated and emphasize values such as
social justice and equity, mental and physical health
and respect for learning are likely to produce better
outcomes than those based on class-room only
information transfer (7,8). Among the most effective
programs are those that promote healthy eating,
physical activity and mental health (4).
Despite the evidence of the success of the HPS
framework, there are few case studies in Australia
that provide insight into how the HPS can be
incorporated into a school, and the practicalities
of becoming a HPS. A number of authors (11,12)
advise that the implementation stage is important,
as are establishing good relations between outside
organizations and holding in-service training.
Rowling and other authors (10,12,18) however,
advise that without structured assistance, school
communities will have difficulty implementing the
HPS framework.

Developing a partnership
Bayswater North Primary School (BNPS) is a
medium sized primary school of 490 students, in a
lower socio-economic community. The school is
situated in an area of Community Renewal which is
funded by the State Department of Planning and
Community Development. Community Renewal
programs target neighborhoods in areas experiencing
growth or decline, or facing difficulties such as falling
employment, poor access to services or run down
community facilities. Community Renewal is part
of A Fairer Victoria, the Victorian Governments
$1.6 billion plan to address disadvantage and
create opportunities for stronger, more resilient
communities (19).
Due to the schools geographic situation within
the Community Renewal area, the local community
health service EACH Social and Community
Health (EACH), which is a partner organization in
the Community Renewal project, approached the
principal of the school to discuss the idea of a
partnership between the two organizations. After
numerous discussions with the senior leadership
team at the school, the EACH health promotion
manager and principal of BNPS signed a three year
partnership agreement in February 2009.
As part of the partnership agreement, the school
agreed to commit staff to participate in a HPS
steering committee, to participate in a whole school
audit, and to engage with planned evaluation of
programs. EACH provided support to the school by
appointing a Health Promotion Officer (HPO) to
work there one day a week, in order to facilitate the
steering committee and follow through with agreed
initiatives.
A sense of ownership in regards to the HPS
program has been identified as a significant factor in
the success of the HPS model (12,16,18). To include
the school staff in the process, the HPO gave a staff
presentation before the partnership agreement was
signed in order to garner buy in from the school
staff. The HPO is also based at the school one day a
week, and shares morning tea and lunch with the
school staff to further develop relationships.
Sharing responsibility for HPS across the school
community has been identified as important, and
steering committees are recommended to share the
work and drive the initiative forward (16,18).
Therefore, shortly after the signing of the partnership

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Original Article

agreement, a HPS committee was formed at BNPS.

The committee is currently made up of two lead
teachers, the assistant principal, three parents and
the HPO. Visitors, such as the school canteen
manager, are invited to attend meetings when
discussing areas of their concern. The committee
agreed to meet approximately once a month.
Having the lead teachers and the assistant principal
present on the committee has given the program
credibility and helped embed the HPS concept
throughout the school (12).

Methods
Study design
To increase the credibility and reliability of the
results, methodological triangulation was employed.
The two methods employed were a written audit,
followed by focus groups. An audit was administered
to school students, teachers and parents. Focus
groups based on the results of the audit were then
held with teachers and students. The use of two or
more aspects of research strengthens the design and
increases the ability to interpret the findings (20).
A school audit for the school community, parents,
teachers and students from grades 3 to 6, was
developed by the HPO based on an audit from the
HPS Toolbox (5). The HPS Toolbox was designed
by the Queensland Government Health Department
to provide practical tools, such as audits, for
implementing the HPS approach in local schools.
Chapter seven, How to Conduct a School Health
Audit, provides examples of audits, along with
advice about gathering information about the health
needs of the school community.
The audit used at BNPS was based on examples
of audits provided in the HPS Toolbox and on
the Asset-based community development model
(ABCD). The ABCD model is based on the principles
of appreciating and mobilizing a communitys talents,
skills and assets. The model looks to the community,
in this case the school, to drive the development,
rather than an external agency (2123).
To evaluate the progress of the HPS program at
BNPS, an action research evaluation model was
employed. As MacNaughton and Hughes state:
action research begins with hopes, dreams and
desires: the hope that we can change the world for

25

the better, the dream of a better world and the

desire to make a difference (24).
The focus of the action research evaluation
method is to move toward change and continuous
improvement within the organization. The emphasis
is not on statistics, but on gathering data which
creates an overall picture of change and organizational
movement. Using the plan, act, observe, reflect cycle
has enabled the school to reflect on their progress
as a HPS, and make changes to the programs as
identified by the school community.
The audit was piloted with the HPS committee
who provided suggestions and changes. The audit
asked only three questions:
What are the three best things about BNPS?
What would you like to see changed at BNPS?
On a scale of one to ten, how healthy do you
think BNPS is? (This question was included only
on the students audit)
The audit was administered to parents, teachers and
students from grade 3 to 6. Teachers administered the
audit to the students during class time, where the
questions were explained and ideas discussed.
Students were given a Likert Scale of smiley images to
colour in for question three. All answers were
anonymous. After the audit was collated, follow up
focus groups were held with six students from each
surveyed grade, making it 24 students in total. Males
and females were equally represented within the
group. Students who participated in the focus groups
were selected by their class teachers and were the
children available at that time. The focus groups were
led by two parents from the HPS committee and the
HPO. This gave the students a chance to elaborate on
the results of the survey. The results of the audit were
also presented at a HPS professional development day
hosted by EACH for the teachers at BNPS. At the
professional development day the teachers were
given an opportunity to provide qualitative input to
the audit through brainstorming and group work.
In keeping with the philosophy of the ABCD
model, it was considered important to use members
of the school community and the parents in holding
the focus groups. In Building Communities from the
Inside Out, Kretzmann and McKnight (23) describe
the ABCD approach that recognizes the talents and
capacities of people in the community and the
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E. Senior

26

importance of using these. If groups begin to deal

more with external institutions than with people in
their own community, it reinforces the notion that
only outside experts can provide real help (23).
Consistency in administering the student
interviews was achieved by the three interviewers
conducting all four focus groups, one after each
other on the same day. A focus group summary
form was completed by all the interviewers
immediately after each focus group. These included
details about emerging themes and ideas generated
within the groups.

Ethics
Permission was received from the school Principal
to administer the audit and focus groups. The
school audit and focus groups are considered part
of the students health curriculum in the unit
Happy Healthy Humans. This is included under the
Health and Physical Activity domain of the
Victorian Essential Learning Standard. This unit
emphasizes the importance of environment on
personal health. On the advice of the school
principal, an ethics clearance was not required.

Analysis
Content analysis was used to analyze both the
audits. Tables with categories were created from
the answers to the audit questions. Each answer
was then coded into one of these categories. When
coding was completed, percentages of times that
particular themes were mentioned were calculated.
Based on grounded theory, this approach is
considered suitable for analyzing transcripts and
open-ended questions (25).
The themes identified from the whole school
audits were then used to design the questions used
in the focus groups. The focus groups gave both the
students and teachers involved an opportunity to
elaborate on the themes that had been identified in
the school audit. The focus groups also allowed for
coding the intensity of participants responses. After
transcription, the responses from the four student
focus groups and teacher focus group led to the
development of three major themes of concern.
These are: canteen and healthy eating, physical
activity, and staff health.

Results
All students in grades 3 to 6 present on the day of
the audit were asked to complete the survey
questions. From grade 3 to 6 students (n = 240),
95% completed the audit, as did 98% of teachers
(n = 19). Unfortunately only 9% (= 26) of parents
completed the survey. Teacher attendance at the
HPS professional development day was 90%, this
gave the majority of teachers a chance to contribute
ideas to the vision of BNPS.
Early on in collation of the audits and through the
focus groups, strong themes began to emerge. There
was early consensus within both the staff and
students of the strengths and weaknesses of BNPS.
Figure 1 shows the results from question one of
the staff audit, What are the three best things about
BNPS? The staff indicated that 41% valued their
fellow staff members as one of the best things about
the school. Qualitative comments included:

Staff are very open and caring

I enjoy the camaraderie at the school
Teachers are open to new ideas
The best thing about the school is the teachers.
I have a lot of friends here

The second most highly rated aspect was the physical

environment of the school, with 22 % of the staff
indicating that this was highly valued.
Table 1 shows the results of question one of the
students audit, What are the three best things about
BNPS? The table shows the highest two answers.
Grades 3 to 6 all indicated that their most highly
rated area of the school involved the outside
environment or aspects of the schools external
environment. Grades 4 and 6 both chose the generic
outside environment, with 13% and 24% respectively.
Grades 3 and 5 also chose features from the external
aspect of the school, the veggie patch (17%) and the
frog bog (22%), as their favorite aspects of the school.
It is interesting that both the staff and students highly
value the outside environment of the school yard.
Figure 2 shows the results from question two of
the staff audit, What would you like to see changed
to promote the health of BNPS? The staff indicated
that 37% of them were concerned with their own
physical activity levels and that of their students.
Qualitative comments included:

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27

45
40
35
30
25
20
15
10
5
0

ui
ttr
ib
af
fA
St

En

nm

vlr

sid

ut

en

te
s

% Responses

Staff Survey: What are the three best things about BNPS?

ilie

am

Pr

am

r
og

nt

e
ud

St

ip

sh

r
de

Le

School Attributes

Figure 1. Results from staff survey (Question 1).

Table 1. Results from student survey, two highest rated answers (Question 1: What are the three best things
about BNPS?).

Grade 3

Grade 4

Grade 5

Grade 6

Outside environment
Veggie Patch
Sport
Frog bog

17%
26%

13%
15%
13%

20%
22%

24%

30%

I would like a staff exercise program

A treadmill in the staff room would be good
The students need more access to sports
equipment at lunch time
Many of the staff and children are not fit
Table 2 shows that Grades 3 to 6 were concerned
with the outside environment, canteen and sport.
Grade 3 also had concerns with the toilets (18%),
and 10% of grade 5 students wanted a swimming
pool! This has also been documented as a popular
request in other research on creating supportive
environments (26).
Comments include:
We need to work in the garden; we need more
trees and possum boxes (grade 6 boy).

We need more sport equipment for lunchtime.

Some is broken and needs to be replaced (grade
6 boy).
More people are needed to serve at the
canteen. The queues are very long (grade 3
girl).
The taps in the toilet are hard to use. Only one
hand can be washed at a time. The mirrors are
damaged (grade 3 girl).
The vegetable garden is good, but we need to
grow more veggies. We always grow the same
thing (grade 4 boy).
Question 3, On a scale of one to ten, how
healthy do you think BNPS is? was included to
explore students perception of their environment
as a healthy one. Out of the total population, 50%
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E. Senior

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% Responses

Staff Survey. What would you like to see

changed at Bayswater North Primary School?
40%
35%
30%
25%
20%
15%
10%
5%
0%

f
af

St

es

itn

th
al

or

in

t
Ea

e
ar

p
up

en

ol

v
In

em

Be

ou

i
av

ri

ur

um

l
cu

lro

nv

f
lE
el
ity
W
oo
un
h
m
Sc
om
C
School Attributes

en

nm

Figure 2. Results from staff survey (Question 2).

Table 2. Results from student survey. (Questions 2:

What would you like to see changed at BNPS?)

Grade3 Grade 4

Grade 5 Grade 6

Canteen
Toilets
Sport
Swimming
pool
Outside
environment

20%
18%

13%

17%

10%

25%

12%

29%

of the students from all of the grades chose seven or

above on the Likert scale. The median choice was
seven. Overall the students perceive BNPS to be a
healthy school.

After the audit

The school audit was collated along with the focus
group material. Thematic analysis was conducted
which identified three key areas of concern. These
three areas are:

canteen and healthy eating;

physical activity; and
staff health.
In conjunction with the HPS committee and senior
staff at the school, a plan was developed for each of
these areas. All of the plans feature multifaceted
interventions and sit within the three HPS domains
identified in the National Framework for Health
Promoting Schools. These are: partnership and
services, school organization ethos and environment,
and curriculum teaching and learning (7).
All of the ideas in the plans come from the school
population, gathered through the school audits,
focus groups and the HPS staff planning day. Ground
work for implementing the plan was scheduled for
late 2009 with actual implementation commencing
with the start of the school year in 2010.
Plans include: a Pilates class for school staff to
respond to staff concerns about their own health,
with the possibility of a parents Pilates class to
attempt to increase parental involvement in the
school. In consultation with the staff and students,
there are plans to re-vamp the school canteen to
bring it into line with current school canteens and

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other school food services policy released in

October 2006 (27). The school has applied for
funding to contribute to a planned fitness track, and
there are plans to run lunch time sports activities
for the students to encourage more physical activity.
Additionally, there are plans to refurbish the
student toilets over the end of year holidays, in
order to have them ready for the school year 2010.

Discussion
It has taken nine months for a partnership agreement
to be signed, a whole school audit completed and
collated and a collaborative action plan agreed on.
This time has been spent establishing relationships and
committees, providing in-service information
opportunities for staff, as well as designing,
administering and collating audits. Conducting a
school audit is considered to be one of the key elements
in establishing a HPS (5,6), and it has certainly been
beneficial in establishing the main health concerns of
the school community. This activity took a large
percentage of the HPOs time and would be difficult
for a member of the teaching staff to organize,
particularly if they also have a large teaching load.
Participation, ownership and an approach based
on democratic decisions are considered the key to
the success of developing a health promoting school
(6,7). This process however is time consuming and
resource intensive. Establishing new committees
requires a lot of support, particularly if the ideas of
the HPS are new to the school and the committee (18).
The audit results of the students and teachers all
indicated common themes in relation to valuing the
outside environment of the school and wanting to
see changes in physical activity and healthy eating.
Although only 9% of parents responded to the
audit, their responses also reflected that of the
students and staff in that the outside environment
is considered one of the most valued attributes, but
they would like to see changes in the areas of sport
and fitness. Parental involvement is a challenge that
has been mentioned in other HPS research (11,12).
Three school parents are involved in the HPS
committee and newsletter items on HPS have been
regularly included in the school newsletter, however
up to this point parental involvement has been
limited. It is envisaged that with the implementation
of the HPS plans in 2010, there will be more
opportunities for parents to participate. Some of

29

these plans include offering Pilates classes to

parents, and providing opportunities to be involved
in the canteen.
The importance of building staff capacity in
relation to the HPS idea has been identified
throughout literature (2,6,12). Staff at BNPS
attended a HPS upskilling and idea generating day
where the philosophy behind the HPS framework
was explained. At the end of the day 60% of the
staff identified that they had a good understanding
of the HPS model, 30% partially and 5% not at all.
5% did not return the survey. In response to this, a
HPS activities report has been placed as a permanent
item on the staff agenda to keep the staff up to date
on what is happening around the school and give
them a chance to contribute. More needs to be done
in this area as the success of the implementation of
HPS will depend largely on the teachers and their
capacity to implement it (2).
Teachers and those working with the HPS frame
work also need to understand that collaboration and
organizational change takes time. A number of
teachers expressed frustration with the length of time
the process was taking. There needs to be recognition
of the time it takes to actively engage a school
community in embracing the HPS ideology (12).

Limitations
The audit used to gather information about the
BNPS is not a validated survey tool. It is adapted
from audits available from the Queensland
Government Health Department.
The school parents who administered the focus
groups with the students had no training in
qualitative interviewing. The focus groups were lead
by the EACH HPO who is experienced and trained
in conducting qualitative interviews. To standardize
the procedure, all four student focus groups were
conducted by the parents and HPO on the same day.
The entire school population was involved in the
school audit, however due to practicalities, only 24
students were involved in the student focus groups.
Using teachers to administer surveys raises issues
of authority and confidentiality. Teachers were used
to hand out the surveys, as when conducting a
survey of the school population involving many
students, this was the only practical way to ensure
that all of the students present on the day had a
chance to participate. Teachers were instructed not
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30

to discuss the survey with their classes, but to

simply hand them to the students. All surveys were
anonymous.

Conclusion
The HPS model is an internationally recognized
framework for providing health promotion activities
in schools (1,4,6,16). However, in Australia, the HPS
framework is generally used in targeted programs,
such as sun protection (28), rather than aiming
for school organizational change. This case analysis
demonstrates that in order for schools to embed
the HPS framework into the fabric of the school,
substantial support is required. The school needs to
feel confident in its ability to implement the
changes required to become a HPS. Authors have
identified that the preliminary stages of the practical
implementation of the HPS framework are essential
for a positive, effective outcome (5-7,12,16). Staff
with the time and commitment to see the changes
implemented, strong leadership from the senior
management of the school, and professional
development for the staff, are all integral to the
success of the HPS model. Schools and those working
with schools need to be prepared for a long term
commitment. At the end of almost one year of
collaboration, BNPS is now poised to enact plans
that have taken all year to develop. There is much
excitement and anticipation in regards to these plans.
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Devenir une cole promotrice de sant : lments cls de la planification

E. Senior
Cet article se penche sur les aspects pratiques de la mise en uvre du Cadre de Rfrence pour une cole
Promotrice de Sant (EPS), notamment sur la conduite dun audit de lcole dans sa globalit, afin de
permettre une cole primaire dadopter avec succs les principes propres une EPS. Un accord de
partenariat a t sign entre un centre de sant communautaire local (EACH) et une cole primaire de
la Banlieue Est de Melbourne, en Australie. Un audit de la communaut scolaire a t men avec quatre
groupes de suivi composs dlves gs de 8 11 ans. Des donnes qualitatives ont t recueillies auprs
de vingt enseignants de cette cole lors dune journe organise par les promoteurs de sant du centre de
sant communautaire, consacre au dveloppement professionnel. Les rsultats de cet audit ont mis en
vidence le fait que les lves de cette tranche dge, ainsi que leurs parents, accordaient une trs grande
importance lenvironnement extrieur de lcole. Le personnel a confr une grande importance aux
qualits du personnel. Les suggestions des lves pour amliorer lcole comprenaient lamlioration de
la cantine et de lenvironnement extrieur. Le personnel se sentait particulirement concern par la
bonne forme physique la fois du personnel et des lves. Les parents ont galement mis en avant la
problmatique dune alimentation saine. La communaut scolaire voit lintrt quil y a adopter le
cadre de rfrence pour une EPS, tout en reconnaissant la ncessit davoir un soutien structur et
continu lcole pour adopter avec succs lapproche des coles promotrices de sant. La communaut
scolaire a besoin de comprendre que le processus vers un changement culturel et environnemental est
lent. Pour appliquer le modle des EPS avec succs, il faut du temps et de la collaboration. Laccent doit
tre mis sur le soutien apport aux enseignants pour changer leur cole de lintrieur. Les aspects
relationnels sont primordiaux. (Global Health Promotion, 2012; 19(1): 23-31)

Relation causale entre le sens de la cohrence et lenvironnement psychosocial

sur le lieu de travail partir de donnes recueillies pendant un an auprs de
jeunes actifs japonais
T. Togari et Y. Yamazaki
Le but de cette tude tait dutiliser des donnes longitudinales et dexaminer pour chaque sexe les quatre
hypothses suivantes sur la relation entre le sens de la cohrence (SC) et lenvironnement professionnel
(EP): (1) une relation bidirectionnelle de cause effet existe; (2) lEP est la cause et le SC est leffet ; (3) le
SC est la cause et lEP est leffet ; et (4) il nexiste pas de relation de cause effet. Des individus masculins
et fminins gs de 20 40 ans vivant au Japon ont t slectionns par un chantillonnage alatoire
stratifi en deux phases, et des questionnaires remplir soi-mme ont t envoys par e-mail entre janvier
et mars 2007 (1re tape). Un suivi a t men de la mme manire de janvier mars 2008 (2me tape). Des
rponses ont t obtenues pour 3965 personnes (ratio de suivi: 82,6%). Cette tude a analys 1291
hommes et 933 femmes qui avaient au moins 25 ans lors de la 1re tape et qui occupaient le mme emploi
pendant les deux priodes. Lanalyse a t ralise laide dun modle dcal crois sous forme de
modlisation par quation structurelle. Lhypothse 2 a t slectionne la fois pour les hommes et les
femmes sur la base du rsultat de comparaisons du modle imbriqu. Ainsi, une relation temporelle de
cause effet a t observe entre le SC et lEP la fois pour les hommes et les femmes, avec lEP comme
tant la cause et le SC comme tant leffet. (Global Health Promotion, 2012; 19(1): 32-42)

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91

Para llegar a ser una Escuela Promotora de Salud: elementos clave de la planificacin
E. Senior
Este trabajo contempla los aspectos prcticos de la ejecucin del marco de la Escuela Promotora de Salud (EPS),
entre ellos, la realizacin de una auditoria en toda la institucin a fin de lograr que una escuela primaria adopte
con xito los principios de las EPS. Se firm un acuerdo de colaboracin entre EACH Social and Community
Health, que es un Centro de Salud Comunitaria local, y una escuela primaria de las afueras de la zona este de
Melbourne (Australia). Se llev a cabo una auditoria de la comunidad escolar para la cual se hizo el seguimiento
de 4 grupos foco de alumnos entre 8 y 11 aos de edad, del 3 al 6 ao. Los datos cuantitativos fueron facilitados
por veinte profesores de la escuela a lo largo de una jornada de desarrollo profesional organizada por el personal
de promocin de la salud del Centro de Salud Comunitaria. Los resultados de la auditoria escolar reflejan que
tanto los estudiantes de los cursos 3 a 6 como los padres valoraban por encima de todo el entorno exterior de
la escuela. El personal de la escuela valoraba por encima de todo los atributos del personal. Entre las sugerencias
de los alumnos figuraba la de mejorar el comedor y el entorno exterior. El personal de la escuela estaba ms
preocupado por la forma fsica tanto propia como de los alumnos. Una de las preocupaciones de los padres era
la ausencia de una dieta sana. La comunidad escolar reconoce el valor de adoptar el marco de la EPS, pero se
constata la necesidad de prestarle un apoyo estructurado y continuado para que pueda aplicar con xito el
enfoque de la EPS. Es necesario que la comunidad escolar entienda que la transicin hacia un cambio cultural y
medioambiental es lenta. Para que el modelo de EPS se aplique con xito se necesita tiempo y colaboracin.
Habra que hacer hincapi en prestar apoyo a los profesores para que cambien la escuela desde dentro. Las
relaciones son importantes. (Global Health Promotion, 2012; 19(1): 23-31)

Relacin causal entre el sentido de la coherencia y el entorno laboral psicosocial

a partir de datos de seguimiento de trabajadores japoneses adultos durante un ao
T.Togari y Y.Yamakazi
El objetivo de este estudio era utilizar datos longitudinales e investigar las siguientes cuatro hiptesis en torno
a la relacin entre el sentido de la coherencia (SC) y el entorno laboral (EL) en razn de los sexos: (1) Existe
una relacin causa efecto bidireccional entre SC y EL; 2) el EL es la causa y el SC es el efecto; 3) el SC es la
causa y el EL es el efecto; y 4) no existe relacin causa efecto entre SC y EL. Se realiz un muestreo aleatorio
estratificado en dos fases con sujetos masculinos y femeninos de edades comprendidas entre los 20 y los
40 aos, residentes en Japn, y se les envi por correo unos cuestionarios autoadministrados entre enero y
marzo 2007 (Etapa 1). Se llev a cabo un seguimiento del mismo modo de enero a marzo de 2008 (Etapa 2).
Se recibieron respuestas de 3.965 personas (ratio de seguimiento: 82,6%). Este estudio analiz las respuestas
de 1.291 varones y 933 mujeres con una edad mnima de 25 aos en la Etapa 1 y que permanecieron en el
mismo trabajo en los dos periodos de tiempo. El anlisis se realiz empleando un modelo de correlacin de
retardos cruzado bajo modelizacin de ecuaciones estructurales. Se eligi la segunda hiptesis tanto para
varones como para mujeres en base al resultado de las comparaciones anidadas. Es decir, se constat una
relacin temporal causa-efecto entre SC y EL tanto en los varones como en las mujeres, en el que el EL era la
causa y el SC era el efecto. (Global Health Promotion, 2012; 19(1): 32-42)

Utilizar las competencias de promocin de la salud para el desarrollo curricular

de la enseanza superior
W. Madsen y T. Bell
Las competencias bsicas de la promocin de la salud se utilizan para diversos fines. Recientemente, se han
dado pasos para lograr un consenso internacional respecto de las competencias que se consideran esenciales
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