Effective health promoting school for better health of children and adolescents: indicators for success.

Background: Improvement of health literacy, health behavioural change, creating a supportive physical and social environment to be more conducive to health should be the focus of child and adolescent public health. The concept of Health Promoting School initiated by World Health Organization aims to move beyond individual behavioural change and to consider organisational structure change such as improvement of the school's physical and social environment. The aim of this study is identification of the key indicators for successful implementation of Health Promoting School by analysing the findings of the school health profile based on the structured framework of Hong Kong Healthy School Award Scheme and the health status of students investigated by the Hong Kong Student Health Survey.

Methods: This is a retrospective correlation study. Analysis of variance (ANOVA) was utilised to analyse for significant improvement of school health profile measured at baseline (n = 104) and among those schools implemented the Hong Kong Healthy School Award Scheme (n = 54). Those indicators showing statistical significance were chosen to be part of the core indicators reflecting effective Health Promoting School. Each of those selected core indicators was then correlated with the related student health outcomes measured by the Hong Kong Student Health Survey Questionnaire to further identify the core indicators.

Results: A total of 20 core indicators among all the six Key Areas of Health Promoting School (6 indicators under action competencies, 2 under community link, 2 under physical environment, 2 under social environment, 4 under healthy school policies, 1 under services of school health protection) have been identified with the method mentioned above.

Conclusions: This study has identified the indicators with most significant impact on a wide range of health related outcomes. Those are key indicators for motivating positive change of the schools and students. They can be considered as school performance indicators to help schools embarking their Health Promoting School journey as another key education objective.