Relevant academic links

Here you can find publications written by or related to the work of the SHE Research Group to stimulate and contribute to evidence on school-based health promotion & education.


Addressing Health Literacy in Schools in Germany

We know that the integration of health literacy into schools is challenging, as both schools and teachers already face numerous educational requirements - and these may prevent them from addressing health in the classroom. Installing health literacy in schools succeeds more easily if it can be linked to existing curricular requirements. Read this newly published paper by two SHE research group members and their colleguages.


Making every school a health-promoting school

The effect of the COVID-19 pandemic on schools has reinforced the links between children's health, wellbeing, and learning. Also the impact of school closures on children's and adolescents' emotional distress and mental health have been obvious, and social inequalities have made conditions worse. The newly global standards for health-promoting schools, published by WHO and UNESCO, is therefore highly valued. Read the paper in the Lancet from 25th June 2021.


Creating health promoting schools will improve population health and help reduce inequalities

The authors of this letter from 24 May 2021, published in the British Medical Journal, argue that schools are a key setting for improving population health and contributing to health inequality reduction - when the schools take responsibility for being supportive environments instead of putting the responsibility for health solely on individuals. Furthermore, the importance of a national government commitment to realise this potential is pointed out. Read the article.


Whole-school-approach and curriculum strategies to increase health literacy

Teachers can create opportunities for students to connect classroom learning activities to everyday life through a focus on health literacy. In Australia (Tasmania), the HealthLit4Kids program aims to build health literacy in a participatory and contextually relevant way. Read this article on how parents view the impact of the HealthLit4Kids program beyond the classroom.


What does co-creation mean? An attempt at definition informed by the perspectives of school health promoters in France

This paper in the Health Education Journal is written by two members of the SHE research group, Emily Darlington and Julien Masson, and is published in May 2021.It states that capacity building and community-level participation are important to enhance the efficiency and sustainability of health promotion programmes, as well as to promote empowerment and decision-making power. Read the paper.


Supporting every school to become a foundation for healthy lives

This article in the Lancet Child & Adolescent Health is an advocacy tool and roadmap for building bridges between education and health and enabling the development of intersectoral practices in schools. It takes stock of the available evidence on school health interventions and the conditions necessary for their effectiveness and sustainability. It calls for an educational look at health issues. Coherence between policies, structures and systems, human resources and practices in each school is necessary to improve school and health outcomes. It shows that health professionals can be catalysts for structural change and act as vehicles for cross-sectoral implementation of innovations in school systems. Read the summary.


A selected collection of articles on health promoting schools

The journal Health Promotion International (HPI) has in March 2021 made a brief overview of the framework on the health promoting school. Relevant papers published in the journal in the periode from from 1992 to 2020 has been collected, covering most of the world’s regions (North America, South America, Europe, Africa, Asia and Australia) and addressing a wide range of health promotion topics. Read the article.


Students´ experiences of learning about mental health in school

This Norwegian article by SHE research group member Anne Torhild Klomsten and her collegue shed lights on pupils` experiences of having mental health as a school subject. The study is based on qualitative interviews with pupils in 9th grade, secondary school. The findings show that students can benefit from learning about mental health as part of cross-curricular subject. Read the article (abstract in English, article in Norwegian).


Dutch study evaluates implementation of health promoting school concept

As part of a Dutch evaluation study on health promoting schools, the degree of implementation was mapped at primary, secondary, and vocational schools. 535 schools (20%) participated. Of those, 355 schools indicated they liked to receive a report that detailed their scores on seven aspects of implementation, relative to all participating schools. The feedback helps schools and regions to get more insight into implementation. Read the article (abstract in English, article in Dutch).


Digital Health Literacy study, Germany

Four members of SHE's research group and collegues focus on digital health literacy and web-based information-seeking behaviors of university students in Germany during the COVID-19 pandemic in this cross-sectional survey study  Read the article.


Adolescents’ Perception of the External School Food Environment

The aim of this Irish study was to explore adolescent’s perception and use of the food environment surrounding their schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. The study was conducted by SHE research group member Saoirse Nic Gabhainn and collegues from National University of Galway. Read the article.


Education outside the classroom

Regular use of education outside the classroom (EOtC) - in the schools' local environment - is a widespread practice in Denmark. In EOtC. A survey, conducted by two of SHE's research group members (Mads Bølling and Peter Bentsen) and their colleguages before the pandemic, showed a stability in how many general schools practiced EOtC compared to 2014. However, in general public schools practicing EOtC, 31.8% more classes used EOtC, compared to 2014. Special-need schools were investigated for the first time and had a 2019-provision of 34.0%. Read the abstract.


Spanish research on determinants of health in adolescence

A study was conducted in a region of northern Spain to analyse the relationship of cardiorespiratory fitness and body composition looking at indicators of mental health, lifestyles and sociodemographic variables. The results determined that being a boy, being younger, sleeping fewer hours at night, and presenting a lower academic performance were predictors of suffering from obesity. On the other hand, lower physical activity engagement, poorer academic performance, being a migrant, and not practicing extracurricular sports activities were predictive factors of cardiorespiratory fitness in the risk zone. Read the article (abstract in English, article in Spanish)


HealthLit4Kids - a school-based health literacy program

HealthLit4Kids is a sequential mixed methods design involving convenience sampling and pre and post intervention measures from multiple sources. A paper published in BMC Public Health describes the research and development protocol for the Australian health literacy program that provides teachers with the resources and supports them to explore the concept of health literacy within their school community, through classroom activities and family and community engagement. Read the article.


Health literacy and COVID-19

Result from the COVID-19 Health Literacy survey show that 43% of German university students experience difficulties in assessing the reliability of COVID-19 information. Social media use is associated with lower health literacy in this area. Researchers from SHE's research group have contributed to this studie - read the article.


Health Promoting Schools: An Update from Hong Kong

As many schools are not able to implement Health Promoting School in its entirety, a starting point for wider implementation is having cores indicators. Hong Kong Healthy School Awards Scheme is devoloped to analyse indicators with significant correlation with better health and well-being and Albert Lee and collegues from the Chineese University of Hongkong have written an article in 2020 about their work. Find the article.


International Handbook of Health Literacy: Research, Practice and Policy across the Life-span

Orkan Okan (from SHE's research group) and collegues have written this handbook on thealth literacy that is available with open access under CC-BY-NC license. It provides an overview of current international thinking about health literacy, highlighting cutting edge research, policy and practice in the field. With a diverse team of contributors, the book addresses health literacy across the life-span and offers insights from different populations and settings. Providing a wide range of major findings, the book outlines current discourse in the field and examines necessary future dialogues and new perspectives. Find the book.


Adherence to a Mediterranean diet in adolescents from the northern Spain

A study by member of SHE’s research group Daniel Arriscado and colleagues analyses the association of multiple factors with adherence to the Mediterranean diet. The study was conducted with a representative sample of 761 adolescents. Forty-nine percent of the adolescent population reported high Mediterranean diet adherence. The female gender and higher levels of physical activity were found to be predictive factors of adherence to the Mediterranean diet. In addition, maximum oxygen consumption, the presence of environments favourable towards physical activity engagement and higher self-esteem were also predictive in females, whilst better academic performance and more nightly sleep were additional predictors in males. Find the article.


Social networks protect vulnable children and young people

On 2nd November 2020, the article 'Conceptualising the social networks of vulnerable children and young people: a systematic review and narrative synthesis' was published in Social Psychiatry and Psychiatric Epidemiology. The review shows that access to social networks protects children and adolescents from negative health outcomes. Read the article.


Review on Peer-led Programmes for Physical Activity Promotion

A new scoping review synthesises knowledge on peer-to-peer approaches to physical activity promotion in school and community settings. Forty-three studies were included. The results are based on an analysis of the theoretical and intervention rationales of these programmes and their reported outcomes. The researchers found great diversity in study designs, intervention approaches and outcome measures, and no clear pattern of factors associated with outcomes. The authors discuss peer-leader roles and engagement in relation to the rationales of peer leadership, in which youth credibility and role modelling are central, and consider how to deliver on the potentials of peer leadership for health promotion. Read the article.


Differences Between Migrant and Native Schoolchildren’s Quality of Life and Habits

The migrant population is an important population in Spain, and understanding their situation will enable increased integration in the social and school environment. A new study, by Daniel Arriscado from SHE’s research group and collegues, analyses the differences between migrants and native schoolchildren. The results show that migrant students presented significantly lower values than native children in socioeconomic status, academic performance, self-esteem, level of physical activity, aerobic capacity, adherence to the Mediterranean diet, body satisfaction and quality of life related to health in all the dimensions except in satisfaction with the educational environment. Read the article.


Reopening Schools During the COVID-19 Pandemic

Evidence to guide countries on reopening schools are sparse and there is continuing uncertainty about the degree to which school children are susceptible to and transmit COVID-19. However, decisions will need to be made based upon currently available evidence and recognising that both reopening schools and keeping them closed carry considerable risk. The article ”Reopening schools during the COVID-19 pandemic: governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure" reviews the benefits and risks of school closure and outlines five key principles for reopening schools. Read the article.


The Ottawa Charter 30 years on: still an important standard for health promotion

WHO's Ottawa Charter for Health Promotion from 1986 is still an extremely important paper, a “gold standard” for health promoters worldwide who wish to improve health and reduce inequalities. This paper examines how the Charter has influenced United Kingdom health care policies by examining two of the Charter’s key strategies, creating healthy environments and reorientating health services. It is argued that the Ottawa Charter retains its relevance to the present day and that all policy makers and professionals working to promote positive health should revisit and take heed of its principles. Published in InternatIonal Journal of Health Promotion and EducatIon, 2018, Vol. 56, no. 2, 73–84


Comparative education in an age of competition and collaboration

In this paper from the journal Comparative Education on 17 Jan 2020, three interlocking trends emphasising the growing relevance of comparative educational research are described: competition, collaboration (across disciplinary, cultural, linguistic, and organisational boundaries) and  comparative knowledge. Read the abstract.


Developing Students’ Action Competence for a Sustainable Future: A Review of Educational Research

The purpose of this review is to provide scholar communities with the current state on the concept of action competence in educational fields. It focuses on transformative learning with teachers as facilitators of students’ learning to help students to take action based on their decisions. The selection of the systematic literature review included 34 articles in the data analysis. The review is published 13 February 2020 in Sustainability.


Research: Gender Differences Relating to Lifestyle Habits

The objective of this Spanish study was to analyse the lifestyle differences associated with the health of adolescents as a function of gender. For this, a cross-sectional study was conducted with a sample of 761 adolescents. Relative to males, females presented significantly lower values for engaging in physical activity, maximal oxygen uptake, physical wellbeing, psychological wellbeing, and body satisfaction. In exchange, females demonstrated higher vegetable consumption in the daily diet and greater satisfaction in the educational context. The differences suggest that educational and health organisations should give more consideration to establishing intervention strategies that are appropriate to the needs of each gender. Read more.


Enhancing the efficacy of health promotion interventions: A focus on the context

Three of SHE research group members, EmilyDarlington, Patricia Mannix-McNamara and DidierJourdan has written an article where the importance of the context when evaluating health promotion programs are emphasied. A better understanding of the interaction between programme and contexts could contribute to upscaling the design of effective health promotion strategies. Identifying implementation patterns could lead action and inform policy development, programme design and practices, and be a way to create useful tools for programme design and implementation. Read the article.


 A Comparative Study on Adolescents’ Health Literacy in Europe: Findings from the HBSC Study

Cross-sectional data from the newest Health Behavior in School-Aged Children (HBSC) study (collected in 2017–2018) were used for this study. A paper made be Leena Paakari from the SHE research group and colleagues reports the findings from ten countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) in total, 14,590 15-year-old pupils, and focuses on health literacy and its  associations with gender, family affluence (FAS), and self-rated health. The findings confirm that there are differences in health literacy levels within and between European countries, and that health literacy does contribute to differences in self-rated health.
Read the article.


The Creating Active Schools Framework (CAS) - a whole-school physical activity framework

Practitioners, policymakers and researchers have codesigned a whole-school Physical Activity (PA) framework, called CAS (Creating Active Schools Framework). The whole-school approach helps to expose the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. Initial and in-service teacher training helped foster teachers’ capability, opportunity and motivation to deliver the whole-school approach and national policy supported it. Read the article 'Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework' by Andy Daly-Smith et al.


COVID-19: health literacy is an underestimated problem

"Health literacy might help people to grasp the reasons behind the recommendations and reflect on outcomes of their various possible actions. However, taking social responsibility, thinking beyond personal interests, and understanding how people make choices—aspects such as ethical viewpoints and behavioural insights—should also be considered within the toolbox of health literacy". This paper by Leena Paakkari and Orkan Okan from 14th April 2020 highlights the importance of health literacy in the time of the COVID-19 pendemic. Read the article.


Health, well-being and education: Building a sustainable future. The Moscow statement on Health Promoting Schools

The purpose of this paper is to introduce the official statement of the Fifth European Conference on Health-Promoting Schools. The conference was held on 20–22 November 2019 in Moscow, Russian Federation, with over 450 participants from 40 countries. SHE has a short version of the Moscow statement on our website, but this paper presents the final statement with six thematic categories (values and principles; environment, climate and health; schools as part of the wider community; non-communicable diseases (NCDs); evidence base; and digital media), with a total of 23 recommendations and calls for action. The writing group consists of Kevin Dadaczynski, Bjarne Bruun Jensen, Nina Grieg Viig, Marjorita Sormunen, Jesper von Seelen, Vladislav Kuchma, Teresa Vilaça, all of them SHE members. Read the article.


The Role of School Leaders’ Health Literacy for the Implementation of Health Promoting Schools

Untill now, only limited empirical studies have addressed health literacy of school staff. But new research shows that the promotion of health literacy would not only result in positive effects on an individual level but also could contribute to a stronger implementation of activities on school health promotion. Read about the cross-sectional study with n = 680 school principals and members of the school management board.
See the article written by Kevin Dadaczynski, Katharina Rathmann, Thomas Hering and Orkan Okan.


Children's Views of 'The Daily Mile' - New Research

Researchers from Swansea University, Wales have published the first mixed-methods study on The Daily Mile, the school-based running programme that is delivered in over 10,000 schools worldwide. Emily Marchant from the SHE research group led the project which explored pupils, teachers and headteachers’ experiences and examined the effect on children’s fitness. Their findings provide a set of recommendations for schools for the effective implementation and sustainability of The Daily Mile. This is the first study to incorporate pupils’ views and highlights the importance of involving children in the design and delivery of programmes like The Daily Mile. See article and news article.


Effective classroom-based Preventive Intervention from Estonia

The PAX Good Behaviour Game (PAX GBG) is a behaviour management strategy that has demonstrated positive effects on children’s and teachers’ wellbeing. The intervention was adapted to Estonia in 2014 and has been implemented in 108 elementary schools. The effectiveness of PAX GBG was evaluated with a two-year, cluster-randomized controlled trial conducted during 2016-2018. This study determined that the intervention had positive and lasting effects on children’s mental health. Read about the effectiveness study.


Addressing Health Literacy in Schools in the WHO European Region

In school, all  children  have  the  right  to  receive  quality  education  on  health  literacy. Any improvement in health literacy skills may benefit the health, growth and development of children, as well as their health in later life and the health of the broader society. In a newly published article,  some  of  the  prerequisites  for  schools  to  become  key  settings  for  health  literacy development in school-aged children, is presented. The  current  state  of  school  health  literacy  policies  within  the  WHO European Region is also  being  discussed.  The article is written by Leena Paakkari, Jo Inchley, Anette Schulz, Martin Weber and Orkan Okan. Read the article.


A systematic review and quality assessment of the evidence of immersive nature-experience for children and adolescents

In this systematic review, the evidence for benefits of direct and deliberate use of public natural environments, e.g. short-termed walking or education outside the classroom, is summarised and assessed. Across heterogeneous types of nature-experience, there was shown conditional support for benefits on self-esteem, self-efficacy, resilience and academic and cognitive performance. Correlational research evidenced higher levels of physical activity in natural environments than comparison conditions. Benefits for outcomes such as self-concept, problem solving, and mood were more inconclusive. The authors are: Mygind, Bølling, Hartmeyer, Kjeldsted, Mygind, & Bentsen (July 2019). Read the review.


A Whole School Physical Activity and Nutrition Intervention

Project Spraoi is an Irish school-based physical activity (PA) and nutrition intervention that reached 473 primary school children and 43 school staff in Cork, Ireland. For 2 school years, intervention schools were assigned an ‘Energizer’, who promoted PA and healthy eating. The evaluation assessed the impact of the intervention on teachers, parents and children. The intervention was associated with smaller waist, slower resting heart rate and favourable nutritional attitudes among 10-year olds. No significant change across other variables or among 6-year olds was found. Teachers, parents and children reported positive outcomes for PA behaviour and nutritional knowledge/ attitudes. Read the article.


Positive Impact of Education Outside the Classroom on Pupil-Pupil Social Relations

Education outside the classroom (EOtC) is found to have a small but positive impact on informal peer affiliations among pupils, i.e. friendship-like relations. Social network analysis in the Danish TEACHOUT study shows that mid-school pupils establish peer affiliations to more new peers when taught school subjects outside the classroom on a weekly basis for a 38 weeks period. Teaching away from school, e.g. museums, forests, and public institutions may require transportation. Time for informal peer-to-peer interaction during transportation seems to retain existing peer affiliations, but do not contribute to new affiliations. The authors are: Bølling, Pfister, Mygind & Nielsen (2019). Read the article.


Whole school physical activity and nutrition intervention

Project Spraoi in Ireland shows two year outcomes of a whole school physical activity and nutrition intervention using the RE-AIM framework. Teachers, parents and children reported positive outcomes for physical activity behaviour and nutritional knowledge/attitudes. Project Spraoi has shown to improve heart rate and prevent further gains in fat mass amongst older aged children. The positive impact of the intervention supports the need for its continued delivery, particularly as children age. Read the article in Irish Educational Studies, The authors are: O’Leary, Rush, Lacey, Burns & Coppinger (2019).


Regular Education Outside the Classroom and Pupils’ Reading Performance

Pupils become better readers when school curricular teaching activities are relocated to places outside the classroom 2-7 hours a week. This finding is independent of subjects taught outside the classroom. No effect of curricular math teaching outside the classroom on math skills was found. These results from the quasi-experimental interventions study TEACHOUT are most important for evaluation of school-based health promotion initiatives to clarify potential positive impacts on core school agenda outcomes because educated children have a healthier lifestyle.
See research papers on education outside the classroom and children’s reading performance (article) and education outside the classroom and children’s math skills (article).


Implementing Physical Activity into Academic Lessons

A Danish study on implementing physical activity in secondary school has been published. The paper describes an intervention study examining the effect of physically active lessons on students’ educational outcomes and the teachers’ perspective on integrating physical activity into academic lessons. The results of this study are expected to provide schools and policy-makers with new insights into the potential of physical acitivity-integrated teaching in secondary school to improve academic achievement and students’ motivation in school. Authors are Ottesen and von Seelen. Read the paper.


(Re)framing school as a setting for promoting health and well-being: a double translation process.

Nordin, Jourdan & Simovska discusses how the setting approach to health promotion in schools is embedded in the Danish policy landscape and enacted at the local governance level. It shows that key principles of the setting approach to health promotion is integrated in the Danish curriculum for health education at national level. But at the municipal level the discourses of disease prevention and individual behaviour regulation has a higher priority than the treatment of schools as settings for promoting health and well-being. Read the paper.


A Transdisciplinary Complex Adaptive Systems (T-CAS) Approach to Developing a National School-Based Culture of Prevention for Health Improvement

Simon et al. describ the structure and underlying theory and approach of the School Health Research Network (SHRN). The article has been published in Prevention Science. It outlines how SHRN has used complex adaptive systems theory to embed itself into the school health system in Wales and move the system towards evidence informed policy and practice. Read the paper.


Adolescent self‐harm prevention and intervention in secondary schools: a survey of staff in England and Wales

A paper focusing on adolescent self-harm has also been published. Using SHRN questionnaire data it investigates secondary schools’ existing provision of adolescent self‐harm prevention and intervention, barriers to delivery of interventions and future needs. Authors: Evans et al. Read the paper.


Education Outside the Classroom and pupil's Social Well-being

New research shows that relocation of school curricular teaching activities to places outside the classroom is related to primary schoolchildren’s psychosocial well‐being. In a quasi-experimental study, children exposed to 2-7 hours of education outside the classroom (EOtC) in average a week for one school-year scored better on prosocial behaviour (for instance helpfulness), compared to children in controled conditions. The education took dominantly place in nature and green areas. The study was part of the Danish TEACHOUT project aiming to investigate physical activity, school motivation, well-being and learning outcomes of an EOtC school-based ‘add-in’ initiative. Research paper on EOtC and Psychosocial Well‐Being. Research paper on ‘add-in’ initiatives.


Multilevel population-based cross-sectional study examining school substance-misuse policy and the use of cannabis, mephedrone and novel psychoactive substances among students aged 11–16 years in schools in Wales

The study showed no effect on the level of drug use among students if they were involved in policy development at their school. The paper by Luke S Midgley, Simon Murphy, Graham Moore, Gillian Hewitt and James White concludes that there are needs for further contextual understanding around the policy-development process and how schools manage drug misuse. Read the paper


Schools for Health and Sustainability: Theory, Research and Practice

Schools for Health and Sustainability: Theory, Research and Practice, edited by Patricia Mannix McNamara and Venka Simovska. Springer 2015


Health Promotion International

In the journal: Health Promotion International you will find many articles written og edited by memebers of the SHE Research Group


Health Education (Emerald Journal)

Health Education (Emerald Journal) has several special issues about health promotion in schools over the years