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The purpose of this study was to evaluate the role of a school health promotion (SHP) advisor in the implementation of the six steps of the Dutch “Schoolbeat” approach, aimed at establishing health promotion policies and activities in secondary schools.

In total, 80 school board members, and 18 prevention coordinators of 18 schools in the Southern Limburg region in The Netherlands completed a written questionnaire on the implementation of the six steps of the Schoolbeat approach, and on their satisfaction with the practical assistance offered by the SHP advisor in implementing the steps, as well as the advisor's organizational competencies.

Only one school implemented the Schoolbeat approach completely, and as intended. Schools were generally satisfied with the practical assistance in the process of implementing the Schoolbeat steps and with the organizational competencies of the SHP advisor. Schools which had partly implemented the Schoolbeat steps were more satisfied with the SHP advisor's practical assistance than schools who had not done so at all.

This study showed that the SHP advisor could make a positive contribution to health promotion in schools. Since this role demands new skills, the competencies of health promotion professionals must be further developed.

Structural school health promotion programs and policies are becoming increasingly important in many countries, and not enough is known about the role of health promotion agencies in structuring school health promotion. This paper describes the positive impact of the SHP advisor.

This case study aimed to examine the factors influencing the implementation of health promotion (HP) policies and programs in secondary schools and the consequences for professional assistance.

Group interviews were held in two schools that represented the best and worst case of implementation of a health promotion program (“Schoolbeat”) in the Southern Limburg region. Both schools were represented by the school manager, the health care coordinator and their school health promotion (SHP) advisor. The main purpose of the group interview was to describe the organization of HP in the school.

Efforts to improve organizational aspects like change management, collaborative support and project management contributed to the implementation of HP.

Based on these results the authors advise SHP advisors to focus more on the organizational aspects of HP in schools.

This study contributes to the discussion about the tasks of HP professionals assisting secondary schools. Results show that effective assistance in shaping school health promotion requires competencies that go beyond organizing practical HP activities. HP professionals assisting schools need skills covering many aspects of the field, ranging from professional assistance for the process of implementing HP to organizational skills to advise and guide schools on the organizational changes needed for the implementation of HP.

The Diagnosis of Sustainable Collaboration (DISC) model (Leurs et al., 2008) specifies five factors (i.e. project management, change management, context, external factors, and stakeholders’ support) which predict whether collaboration becomes strong and stable. The purpose of this paper is to study the dynamics of these factors in a study of multiple partnerships in comprehensive school health promotion (CSHP).

A Dutch two-year DISC-based intervention to support coordinators of five CSHP partnerships in the systematic development of intersectoral collaboration was studied in a pretest-posttest design. To uncover the determinants of sustainable collaboration and implementation of CSHP and to find possible mediators, the authors carried out multi-level path analyses of data on the DISC factors obtained from 90 respondents (response of approached respondents: 57 percent) at pretest and 69 respondents (52 percent) at posttest. Mediation mechanisms were assessed using joint significance tests.

The five DISC factors were important predictors of implementation of CSHP (explained variance: 26 percent) and sustainable collaboration (explained variance: 21 percent). For both outcomes, stakeholders’ support proved to be the most important factor. Regarding sustainable collaboration, mediation analysis showed that stakeholders’ support fully mediated the effects of change management, project management, external factors and context. This indicates that the extent of stakeholders’ support (e.g. appreciation of goals and high levels of commitment) determines whether collaboration becomes sustainable. The authors also found that the extent of stakeholders’ support in turn depends upon a well-functioning project management structure, the employment of change management principles (e.g. creation of a common vision and employment of appropriate change strategies), a favorable organizational context (e.g. positive experience with previous collaboration) and external context (e.g. positive attitudes of financing bodies and supporting health and educational policies). For the actual implementation of CSHP, partial mediation by the support factor was found. There was a direct positive effect of change management indicating that organizational knowledge is also necessary to implement CSHP, and a direct negative effect of project management, probably pointing to the negative effects of too much negotiation in the collaboration.

A design lacking a control group, a small sample and a relatively early assessment after implementation support stopped limit the generalizability of the results.

Strategies targeting the DISC factors can enhance stakeholders’ support and thereby promote sustainable intersectoral collaboration and the implementation of CSHP.

The DISC model provides a fruitful conceptual framework for the study of predictors and processes in public health partnerships. The importance of stakeholders’ support and other factors in the model are demonstrated.

Intersectoral collaboration is often a prerequisite for effective interventions in public health. The purpose of this paper is to assess the facilitating and hindering conditions regarding intersectoral collaboration between health authorities, public health services (PHSs), public services stakeholders (PPSs) and the education sector in comprehensive school health promotion (CSHP) in the Netherlands.

CSHP collaborations in five Dutch regions were studied using a questionnaire based on the DIagnosis of Sustainable Collaboration (DISC) model, focusing on: change management; perceptions, intentions and actions of collaborating parties; project organization; and factors in the wider context. Univariate and multivariate analyses with bootstrapping were applied to 106 respondents (62 percent response).

A similar pattern of facilitating and hindering conditions emerged for the five regions, showing positive perceptions, but fewer positive intentions and actions. An overall favorable internal and external context for collaboration was found, but limited by bureaucratic procedures and prioritizing stakeholders’ own organizational goals. Change management was rarely applied. Some differences between sectors emerged, with greatest support for collaboration found among the coordinating organizations (PHSs) and least support among the financing organization (municipalities).

The generalization of the findings is limited to the initial formation stage of collaboration, and may be affected by selection bias, small sample size and possible impact of interdepartmental collaboration within organizations.

The authors recommend establishing stronger change management to facilitate translation of positive perceptions into intentions and actions, and coordination of divergent organizational structures and orientations among collaborating parties.

The results show that it is valuable for collaborating parties to conduct DISC analyses to improve intersectoral collaboration in CSHP.

Achieving organisational learning and greater specificity for implementation action for health‐promoting schools requires detailed understanding of the necessary components. They include: preparing and planning for school development, policy and institutional anchoring, professional development and learning, leadership and management practices, relational and organisational context, student participation, partnerships and networking, and sustainability. This paper seeks to elaborate a theoretically based rationale for how these eight components of implementation that needs to be put into action.

Building on the narrative synthesis in the complementary paper (“Theoretical base for implementation components of health‐promoting schools”, this issue), examples drawn from empirical research and evaluation reports in the field of health‐promoting schools are used to operationalise the function of the components.

This elaboration anchors specific implementation actions within their own theoretical and empirical base, a significant advance on previous guidelines. The eight components have been articulated separately. However, in practice they operate interdependently. Context and culture issues also need to be accommodated.

The level of specificity provided in this paper has the potential to enhance school staff professional learning, as it fulfils one of the characteristics for successful school‐based education, namely practical, detailed implementation and enough flexibility, allowing shaping to suit specific contexts.

The identification of this knowledge base should enable practitioners to develop an in‐depth understanding of the operational functioning of existing guidelines, thereby enhancing their practice. The specificity provided holds promise to enhance the science base and quality of implementation.

The purpose of this paper is to report the formative evaluation results from the Association for Supervision and Curriculum Development Healthy School Communities (HSC) pilot project.

This study utilized 11 HSC pilot sites in the USA (eight sites) and Canada (three sites). The evaluation question was “What are the levers of change in a school community that allow for the initiation and implementation of best practice and policy for improving school health?” Pre- and post-site visits along with in-depth interviews with school teams, teachers, students, administrators, community stakeholders and other involved individuals, school site report reviews, Healthy School Report Card results and school improvement plans were used for evaluation purposes.

This study identified nine levers of change: principal as leader of the HSC efforts; active and engaged leadership; distributive team leadership; effective use of data for continuous school improvement; integration of the HSC process with the school improvement process; ongoing and embedded professional development; authentic and mutually beneficial community collaborations; stakeholder support of the local HSC effort; and creation or modification of school policy related to HSC that increased the likelihood that school improvement via health promotion would be pursued and sustained.

Owing to the qualitative methods used in this study and the number of schools in the pilot project, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed evaluation question further.

This study has implications for schools seeking to create sustainable, systemic integration of health and education for effective health-promoting schools and continuous school improvement.

This study provides evidence that integration of health and education can become a sustainable and integral part of a school’s culture.