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From Complex Interventions to Complex Systems: Using Social Network Analysis to Understand School Engagement with Health and Wellbeing
Open AccessArticle

The Moderating Role of the School Context on the Effects of the Healthy Primary School of the Future

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Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Academic Collaborative Centre for Public Health Limburg, Public Health Services, P.O. Box 33, 6400 AA Heerlen, The Netherlands
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Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Department of Nutritional and Movement Sciences, Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(13), 2432; https://doi.org/10.3390/ijerph16132432
Received: 13 June 2019 / Revised: 2 July 2019 / Accepted: 4 July 2019 / Published: 9 July 2019
(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)
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Abstract

Background: The current study investigated the moderating role of the school context on the effects of a Dutch health promoting school initiative on children’s health and health behaviors. Methods: The study used a mixed-methods design. The school context (n = 4) was assessed by the characteristics of the school population, teacher’s health-promoting (HP) practices, implementers’ perceived barriers, school’s HP elements, and dominating organizational issues. Outcomes included objectively assessed BMI z-scores and physical activity (PA), and parent and child-reported dietary intake. Analyses included linear mixed models (four intervention schools versus four control schools), and qualitative comparisons between intervention schools with similar HP changes. Results: Effects on outcomes varied considerably across schools (e.g., range in effect size on light PA of 0.01–0.26). Potentially moderating contextual aspects were the child’s socioeconomic background and baseline health behaviors; practices and perceived barriers of employees; and organizational issues at a school level. Conclusions: Similar HP changes lead to different outcomes across schools due to differences in the school context. The adoption of a complex adaptive systems perspective contributes to a better understanding of the variation in effects and it can provide insight on which contextual aspects to focus on or intervene in to optimize the effects of HP initiatives. View Full-Text
Keywords: complex adaptive systems; health promoting schools; mixed-methods design; moderators; qualitative comparison; quasi-experimental design; school context complex adaptive systems; health promoting schools; mixed-methods design; moderators; qualitative comparison; quasi-experimental design; school context
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Bartelink, N.; van Assema, P.; Jansen, M.; Savelberg, H.; Kremers, S. The Moderating Role of the School Context on the Effects of the Healthy Primary School of the Future. Int. J. Environ. Res. Public Health 2019, 16, 2432.

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