Strategies for implementing Health-Promoting Schools in a province in China.

After successful pilot projects in 10 schools (four schools with tobacco control and six schools with nutrition interventions, plus 10 control schools), Health and Education officials in Zhejiang Province, China, decided to scale up Health-Promoting Schools (HPS) systematically over the entire province, starting with an initial cohort of 51 additional schools, reaching from primary to vocational schools. Interviews with school personnel during the first phase of scaling up illuminated the key pre-implementation, implementation, and monitoring and evaluation activities. Pre-implementation activities included choosing an entry point, setting up a special HPS committee, and establishing a work plan. Implementation activities included conducting mobilization meetings, prioritizing health, popularizing the HPS concept, ensuring community cooperation and participation, acting as role models, offering training, and using new teaching and learning methods. Monitoring and evaluation activities included process, baseline, and final evaluations and changing standards of evaluation to a more holistic evaluation that schools go through to become Health-Promoting Schools. Schools also reported that they faced - and overcame - a number of challenges including understanding and integrating the HPS concept and lack of professional development and support. Results revealed that schools transitioned from a passive model of education to interactive pedagogy put priority on health and viewed it as a co-responsibility, reshaped assessment to a more holistic approach and called for more training and technical support. Participants mentioned that they gained knowledge and skills and developed a deeper understanding about health. Health impact was also demonstrated, for instance in reduced injuries and reduced smoking, and educational impact was demonstrated, for instance in improved relationships of children to parents and teachers, improved social qualities, and improved teacher satisfaction.