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The aim of this paper is to identify the role of the principal in establishing a whole school approach for health and wellbeing. Two questions are asked: (1) What do successful Swedish principals do when they take on a whole school approach? (2) How do these results relate to previous research on successful school leadership?

This paper focuses on the complexity of organisational processes and considers the role of successful leadership in managing a whole school approach to health promotion. It presents findings from two different but interlinked projects, and draws on document studies and interviews with principals, student health team members and teachers in Sweden.

This paper argues that successful school leaders are crucial in establishing a whole school approach, because of the work they do to synchronise the health-promoting activities in schools. The study identifies four aspects of coordination that need to be enacted simultaneously when leading health-promoting processes. The fifth aspect identified is that a whole school approach is not limited to the school, but the whole local school context, i.e. a synchronisation between different system levels.

Although limited in scale, this paper reports key findings that could have practical implications for school leaders. The study suggests that successful school leadership research needs to use a health-promoting lens in order to make leadership practices health-promoting practices. It also proposes extended comparative research from different fields and contexts.

The purpose of this paper is to introduce the official statement of the Fifth European Conference on Health-Promoting Schools.

The Fifth European Conference on Health-Promoting Schools was held on 20–22 November 2019 in Moscow, Russian Federation, with over 450 participants from 40 countries. A writing group was established to prepare a draft version of the statement before the conference. On the basis of an online and offline feedback process, the opinions of the participants were collected during the conference and included in the finalisation of the statement.

The final conference statement comprises 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 recommendations and calls for action reflect current challenges for Health Promoting Schools in Europe. They are addressed to all actors in governmental, non-governmental and other organisations at international, national and regional levels involved in health promotion in schools and are to be applied for the further development of the concept.

This study explores to what extent health promotion policy in practice and leadership engagement is reflected in school actors' experiences of health dialogues (HDs) and their ideas about promoting health and learning in schools.

The 93 participants consisted of 44 school nurses, 37 students in grades 4, 7 or the first year of high school and 12 teachers, who shared their experiences with HDs by writing open letters.

The qualitative content analysis resulted in four themes: Putting health on the agenda, Finding a common goal, Walking side by side and Pointing out a healthy direction. The participants' expectations of school health promotion leadership are revealed in suggestions on how the HDs can fulfill both the educational assignment and promote student health.

Based on the findings, we argue that for successful school health promotion leaders need to acknowledge the field of tension where leadership has to take place, anchor health promotion policy and administer “a Sandwich approach” – a top-down and bottom-up leadership simultaneously that facilitates school-based health promotion.

When different school actors (school nurses, teachers and students) are given a voice, a collective picture of HDs can emerge and help develop health promotion practices.

To gain insight into factors enhancing or obstructing implementation in various school-settings, which is vital for widespread dissemination and sustainable integration of school-based health-promoting interventions.

A mixed methods multisite comparative case study to investigate (factors influencing) the implementation of health-promoting activities in twelve Dutch primary schools. Data were collected during three school years (2019–2022) through observations, questionnaires and interviews.

The project resulted in the implementation of small, incidental activities. Important reasons for the limited implementation were lack of commitment and bottom-up involvement. School directors and teachers were not involved early on in the project, which limited project support and commitment. On school level, directors largely carried project responsibility themselves, hindering project sustainability and integration. Coronavirus disease 2019 (COVID-19) made that schools had difficulties forming long-term visions and plans. Other observed barriers included limited perceived necessity to change, high workload and high staff turnover. Important facilitators were the presence of a process coordinator and sharing experiences from other schools.

This research provided valuable insights into (factors influencing) the implementation of health-promoting initiatives in diverse, real-world school contexts. More extensive support is needed to create commitment, bottom-up involvement and a project vision. Furthermore, empowering in-school champions and/or school-wide project groups is desirable to decrease schools' dependence on long-term external support. The findings can be used by various stakeholders throughout development, adoption and implementation and can facilitate widespread dissemination and sustainable integration of school-based health-promoting interventions.

Adapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra.

In 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews.

Navigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy.

The implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered.

This study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

The teaching of cooking is an important aspect of school-based efforts to promote healthy diets among children, and is frequently done by external agencies. Within a limited evidence base relating to cooking interventions in schools, there are important questions about how interventions are integrated within school settings. The purpose of this paper is to examine how a mobile classroom (Cooking Bus) sought to strengthen connections between schools and cooking, and drawing on the concept of the sociotechnical network, theorise the interactions between the Bus and school contexts.

Methods comprised a postal questionnaire to 76 schools which had received a Bus visit, and case studies of the Bus’ work in five schools, including a range of school sizes and urban/rural locations. Case studies comprised observation of Cooking Bus sessions, and interviews with school staff.

The Cooking Bus forged connections with schools through aligning intervention and schools’ goals, focussing on pupils’ cooking skills, training teachers and contributing to schools’ existing cooking-related activities. The Bus expanded its sociotechnical network through post-visit integration of cooking activities within schools, particularly teachers’ use of intervention cooking kits.

The paper highlights the need for research on the long-term impacts of school cooking interventions, and better understanding of the interaction between interventions and school contexts.

This paper adds to the limited evidence base on school-based cooking interventions by theorising how cooking interventions relate to school settings, and how they may achieve integration.

The purpose of this paper is to explore the process of involving students and staff on school action groups, and staff and student experiences of reviewing local data and initiating school-level changes, to address bullying and other aggression.

The authors draw on qualitative, process data collected at four purposively sampled pilot intervention schools in England via semi-structured interviews with school managers, action group members and facilitators (n=33), focus groups with students (n=16) and staff (n=4), and observations.

School staff used multiple methods to recruit a diverse range of students onto school action groups. Locally tailored data reports were an important catalyst for action groups to identify priorities and plan whole school change – both through the process of “validation” (whereby existing concerns were confirmed) and “discovery” (whereby new problems were identified). An unexpected benefit of providing schools with these data was that it triggered analyses of other data sources, including routine monitoring data. External facilitators were important in promoting student voice and ensuring the intervention retained integrity as a whole-school restorative approach.

It was feasible to involve young people using action groups, and there was evidence of school-level actions led by students, including in disadvantaged school contexts. Future Health Promoting Schools interventions could incorporate this approach to support locally appropriate, school-level change.

The micro-level processes that were observed, whereby action groups interrogated feedback reports and collected additional data, suggest the responsiveness of such youth-involvement interventions to local needs. Contrary to many public health interventions, implementation appeared to be facilitated rather than hindered by features of the secondary-school “market” whereby parents have some choice between schools.

The purpose of this paper is to examine the effectiveness of oral hygiene promoting program (OHPP) using a smartphone endomicroscope among students in elementary schools in Bangkok, Thailand, to enable their oral hygiene maintenance and to compare oral health outcomes in the intervention program between the experimental and control groups.

This is a quasi-experimental research study consisting of two groups, a pretest, a posttest and a follow-up design. The student sample consisted of 59 fifth graders who matched the study criteria on medium and low levels of teeth brushing skills. There were 29 experimental group participants who completed the six-week OHPP using a smartphone endomicroscope. Another 30 participants formed the control group involved in the ordinary oral health education program. The comparison data for oral health behaviors (knowledge, attitude and practice (KAP)) and oral hygiene were statistically analyzed by using multivariate analysis of variance (MANOVA).

Results indicated that the experimental group exhibited higher oral health behaviors regarding KAPs and oral hygiene related to teeth cleanliness and gum health than the control group in the postexperimental and follow-up phases. However, there were no statistically significant differences between the two groups with regard to tongue cleanliness.

The students maintain their own oral hygiene due to a provision of activities related to KAP concerns. The instrument helped the students to find tooth decay and dental plaque associated with teeth cleanliness after brushing their teeth.

Models of Child Health Appraised (MOCHA) defines school health services (SHSs) as those that exist due to a formal arrangement between educational institutions and primary health care. SHSs are unique in that they are designed exclusively to address the needs of children and adolescents in this age group and setting.

We investigated SHSs have been provided to schools and how they contribute to primary healthcare services for school children. We did this by mapping the national school health systems against the standards of the World Health Organization, and against a framework measuring the strength of primary care, adapting this from an existing, adult-focused framework.

We found that all but two countries in the European Union and European Economic Area have SHSs. There, however, remains a need for much greater investment in the professional workforce to run the services, including training to ensure appropriateness and acceptability to young people. Greater collaboration between SHSs and primary care services would lead to better coordination and the potential for better health (and educational) outcomes. Involving young people and families in the design of SHSs and as participants in its outputs would also improve school health.

Recent reviews and reports have highlighted the need for integrated, context-specific efforts to enable sustainable food transitions. This study aimed to identify pathways to promote healthier and more environmentally friendly food practices in school contexts, with a focus on increased plant-based eating.

The study used a systemic approach with data collected from relevant stakeholders in an EU country (Portugal) at diverse levels of influence in the school meals system (i.e. proximal, intermediate, distal; from end-consumers to food providers, market actors, civil society organizations, and policy and decision-makers). Data from individual interviews (N = 33) were subjected to thematic analysis.

Meat-centric cultural perceptions of a ‘proper meal’ can be a socio-emotional barrier for sustainable food transitions in schools. Main pathways identified to unlock these transitions included: (1) Levering orientations toward ethical and environmentally beneficial consumption; (2) Improving and increasing the offer of plant-based meals; and (3) Mobilizing local communities and society.

The current findings suggest that promoting healthier and more environmentally friendly food practices in schools requires systemic, integrated approaches which focus on food consumption, food provision, and the broader political and sociocultural environment.